Using simulation to increase respiratory training opportunities and improve patient safety

Thursday, August 24, 2023

Here we learn more about how national pleural ultrasound academies are supporting improvements in simulation training.

Through his work producing the respiratory Getting it Right First Time (GIRFT) reports, Dr Martin Allen has been instrumental in improving the quality of and access to simulation training. Here we outline the importance of pleural ultrasound simulation and how it is being expanded.


Firstly, please can you outline the importance of pleural ultrasound training?

A National Patient Safety Alert in 2008 placed ultrasound and pleural procedural safety high on the national agenda. As a consequence, bedside thoracic ultrasound at the time of intervention for pleural fluid has become mandatory, and training in thoracic ultrasound has become ever more important.

Prior to the availability of simulators, pleural safety training was delivered using a blend of models and teaching sessions. Healthcare professionals could access some specific practical ultrasound courses which involved volunteer patients, but otherwise it was bedside training on a one-to-one basis that provided much of the education. The COVID-19 pandemic reduced experiential learning significantly which exposed a training need in relation to safe ultrasound practice.

The British Thoracic Society (BTS) has a long track record of supporting training in thoracic ultrasound, including the publication of the BTS Training Standard in 2020. This important document outlines different levels of operator competence to facilitate safe ultrasound delivery.


What role can simulation play?

Respiratory trainees are a key audience for ultrasound training, but other healthcare professionals are increasingly seeking training.

Simulation provides people with the opportunity not just to build on initial foundation skills, but also provides a platform for them to refresh their skills.

When respiratory trainees, and other professionals involved in thoracic ultrasound begin their training, it is important they are familiar with the basics which are not always available to see when learning at the bedside. Simulation provides a structured approach to explore and learn the more common procedures, such as pleural effusion through to more complex presentations such as pleural nodules.

A huge advantage of simulation is being able to learn in one sitting, at a time convenient to the learner, therefore making training and education more inclusive.


How is simulation being supported at a national level?

Ultrasound Academies are supported across the 4 nations and are considered a vital way to improve collaborative training opportunities.

NHSE has worked to establish ultrasound academies. Collaborations are in place with the National Imaging Academy Wales (NIAW) and a national ultrasound training programme is in place in Scotland.


What are the latest developments in simulation?

There have been huge advances in simulation models, an example being the BodyWorks Eve systems.

Dr Martin Allen asked Dr Andrew Stanton and Dr Duneesha de Fonseka, both respiratory consultants with specific expertise in pleural procedures, to help explore how simulation could support all relevant healthcare professionals to achieve the requirements outlined in the BTS training standard document.

Martin, Andrew and Duneesha worked with Intelligent Ultrasound (IU) to consider which additional pathologies could be added to the existing Eve system.

The updated system has a wider range of pathologies available to review and discuss in a safe, simulated environment, along with highlighting potential clinical issues. The images are high quality and reflect what is seen in real life. Helping learners to begin to understand how to manage pleural disease, and how to act on the ultrasound findings to plan and deliver the appropriate pleural intervention in a simulated environment, is an invaluable learning experience.

The updated BodyWorks Eve 4.5 with the range of new pathologies will be available from Sept 2023.