Education

Advanced Crisis Resource Management (ACRM)

The ACRM is a high-fidelity simulation-based teaching program that is designed to equip the anaesthesia residents (of all levels of seniority) and transitional-year trainees with the foundations of crisis management. The program involves full scale simulation, team training, application of part-task skills learnt through prior training and highlights the importance of closed-loop communications within the team and across the care teams.
The active hands-on sessions will be followed by structured participatory feedback from trained faculty with key references to expected standards and clinical updates. Audio-visual and technological inputs from the props will be planned for providing immersive experiences that emulate operating theatres, post anaesthesia care units and acute care settings.

Cardiac Anaesthesia Simulation Training (CAST)

Cardiac Anaesthesia Simulation Training (CAST) aims to expose anaesthesia residents to the knowledge and clinical skills required for dealing with emergencies that may occur during cardiac surgery. The simulation is usually carried out during or after the residents first cardiac posting. Example scenarios used in the past have included difficult weaning from cardiopulmonary bypass and protamine reaction. CAST also incorporates the use of transesophageal echocardiography (TEE) and decision making based on TEE evaluation.

Cardiothoracic Intensive Care Crisis and Emergency Management (CICCEM)

Cardiac Intensive care represents the “perfect storm”: a dangerous mix of a high-stakes environment with potential harm to the patient combined with providers who often have not had sufficient opportunity to manage critically ill patients. It is in this setting that effective teaching of the different human and behavioral factors encompassing crises management have shown a directly positive impact on patient outcomes. The CICCEM programme aims at inculcating the principles of crises management among the ICU team - the nursing staff, respiratory therapists, surgeons, and the ICU doctors through high fidelity simulation. The CICCEM programme has been running successfully at MD6 simulation lab for the past 8 years and has received testimonials of appreciation and widespread acceptance amongst the stakeholders and has helped create a high-quality team training programme for medical and nursing professionals to improve patient outcomes in ICU.

Children Emergency Mock Code

A dedicated team at the Children's Emergency department conducts monthly Mock Codes in conjunction with the CHS to offer high fidelity experiences and interaction in managing life-threatening and complex conditions.
The programmes and mannequins utilised are tailored to the uniqueness of the paediatric population and their anatomy and physiology. Real time outcomes of the participants involvement simulate real life development and progression of injuries and illnesses. This offers participants, ranging from interns, nurses, and doctors, opportunities to develop and refine resuscitation skills and teamwork.

ECMO Crises Management Programme

ECMO teams care for the most critically ill patients using a highly complex technology that is significantly different than conventional critical care equipment. To be effective, providers require specialized training to be able to appropriately manage a patient on this type of support. There are a multitude of factors that increase the risk of medical errors in these cases, and a robust curriculum for initial training and continuing education are vital to help protect patients from possible adverse outcomes. An ECMO team is, by necessity, multidisciplinary and includes intensive care physicians, surgeons, perfusionists, nurse practitioners, physician’s assistants, respiratory therapists, and nursing staff. Each discipline is educated in an individual silo, but providers are expected to function well with all other members of the healthcare team. Utilizing simulation to train ECMO teams is particularly beneficial for the ability to recreate low frequency, high-risk situations where clear, concise communication could mean the difference between life and death. This can also provide a forum to improve team behaviors among members of the multidisciplinary group of providers, which are vital for patient safety. We run an ECMO crises management course at MD6 since 2017 and this has been accredited for training of participants by the Extracorporeal Life Support Organization, making it the only training center in Singapore and the second one in Asia Pacific for providing structured education to ECMO specialists.

EMD Exam Prep Tutorial Series (EPTS)

The EPTS programme is a series of tutorials conducted for the NUH Emergency Medicine junior residents who are preparing for their intermediate exams. The course aims to hone the candidates' skills in procedural techniques, resuscitation of medical emergencies, as well as history and physical examination via simulation. The content covered in this course was designed based on common clinical scenarios seen in an emergency department to refine the skills expected of a senior resident as well as to provide confidence in an examination setting.

EMD Procedural Skills Training and Simulation

The procedural simulation training program is designed to train medical officers in practical skills that are commonly practised in NUH Emergency Department. These include skills such as toilet and suturing, backslab application and management of common ear, nose, throat conditions. Cardiac and airway simulations are also conducted to familiarise medical officers with management and resuscitation of critically ill patients with cardiac and airway issues.

Lumbar Puncture Workshop

Lumbar puncture with examination of the cerebrospinal fluid is an important diagnostic tool for a variety of infectious and non-infectious neurologic conditions. It is important for the performing physician to be well versed with techniques, indications, and complications of LP. This LP workshop aims to address these requirements.

Managing Emergency Paediatrics Anaesthesia (MEPA)

MEPA is a paediatric simulation course conducted by the Department of Anaesthesia. It is aimed at helping anaesthesia trainees and anaesthetic nurses gain expertise and confidence in manage paediatric anaesthesia emergencies. Through the various simulation scenarios, both technical and non-technical skills essential in paediatric anaesthesia can be learnt experientially via application of knowledge into practice. Each simulation scenario is followed by a debriefing session, where reflection and consolidation of learning can be enhanced.

NUH Emergency Medicine Core Conference (NUH EMCC)

The NUH Emergency Medicine Core Conference is a new programme for NUH Emergency Medicine junior residents in which the contents run parallel to the national Emergency Medicine Core Curriculum. This programme was created to assist in the transition of junior residents to senior residency by providing a platform which they can learn both from senior faculty as well as their peers through discussions and hands-on simulation practice. These sessions also aim to reinforce clinical knowledge gained during the national EMCC by covering core topics at a more in-depth level.

Open Heart Resuscitation Programme

The care of the patient in Cardiothoracic intensive care unit [CTICU] involves a close-knitted multidisciplinary team all the way from operating theatre. These involve nurses, respiratory therapists, cardiothoracic surgeons, and ICU doctors. An open-heart resuscitation in CTICU, even though rare, represents a rare but stressful crises scenario. Facilitating learning in such a complex environment can be challenging as these healthcare professionals are from different disciplines, considering that there are different learning styles and needs from everyone, making it a daunting task to develop a training program of “one size fit all”. To foster effective delivery of safe, high-quality care for patient, the open-heart resuscitation programme is being run at MD6 simlab on a specialised custom-made manikin- TOM to enable and enhance staff competency in adult open cardiac resuscitation for the past 6 years. Combining multimedia technology, e-learning and high-fidelity simulation using well-staged and realistic scenarios followed by debriefing sessions has resulted in a promising educational tool for these multidisciplinary health-care providers.

Paediatric Acute Emergency Simulation for House Officers and Residents

Paediatric house officers and residents are provided with high fidelity simulation training in the areas of paediatric acute emergencies and resuscitation. Scenarios cover respiratory and circulatory emergencies as well as cardiac rhythm abnormalities and cardiac arrest. This provides a safe environment for practice and debriefing to better prepare our doctors to manage such emergencies in the real clinical environment. Paediatric emergencies are not common and so simulation fills the gap of opportunistic on-the-job learning for doctors in training and increases their confidence with managing emergencies and dealing with situations on call.

Paeds Moderate Sedation Course

This course is meant for doctors or clinicians involved with paediatric sedation. It is meant to teach them the skills they need to know to be able to properly conduct sedation safely for paediatric patients. It focuses on teaching the importance of airway management, logistics of conducting sedation in various areas of the hospital, how sedation is conducted and the more common sedatives that are used. The course is structured around 3 main lectures, a test and skills stations involving simulations to try and give some hands on experience that would be necessary to conduct sedation on live patients.

R1 CEP Simulation Programme

The CEP Simulation Programme comprises of the following:

• Simulation (SIM) Teaching
  SIM Teaching provides PGY1s with hands-on experience in managing medical conditions and emergencies in a controlled environment using life-sized manikins.
• Virtual Simulation - Full Code® Application
  PGY1s at NUH are provided access to Full Code®, an application developed by our faculty to impart the management of common emergency situations and medical cases.

SICU-OBS IPE Simulation / REACT

The REACT module is designed to introduce care pathways of critical ill mother during peri partum period with focus on early recognition and active communication between different disciplines which include, obstetricians, midwifes, SICU medical and nursing teams. It includes scenarios which are acute and pose immediate threat to life of mother and child. Some of this are uncommon scenarios thus giving opportunity to familiarize with pathophysiological changes and relevant diagnostic and therapeutic modality available for same. Target participants are residents from anesthesia OG, midwives and SICU nurses, they learn to work as team, take ownership of care and follow up with planned care. Salient points of care are then feedback to participant as take home message.

Simulation for Anaesthesia in Liver Transplantation (SALT)

Simulation for Anaesthesia/Critical Care training in Liver Transplantation (SALT) is a workshop designed to help participants familiarise with the perioperative management of a liver transplant case, which can be stressful and complex in reali-life. SALT provides a safe learning opportunity to explore and understand challenges and situations which may be unique to liver transplantation. The workshop caters to Liver transplant anaesthetists, critical care physicians and anaesthetiic nurses who might be involved in the perioperative care of a liver transplant patient.