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Creating a gold medal Olympic and Paralympics health care team: a satisfaction survey of the mobile medical… Brown, D R; Heidary, Behrouz; Bell, Nathaniel; Appleton, Leanne; Simons, Richard K; Evans, David C; Hameed, S M; Taunton, Jack; Khwaja, Kosar; O’Connor, Michael; Garraway, Naisan; Hennecke, Peter; Kuipers, Donna; Taulu, Tracey; Quinn, Lori Nov 13, 2013

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RESEARCH ARTICLE Open AccessCreating a gold medal Olympic and Paralympicshealth care team: a satisfaction survey of themobile medical unit/polyclinic team training forthe Vancouver 2010 winter gamesD Ross Brown1,2,3*, Behrouz Heidary1,2, Nathaniel Bell1,2,8, Leanne Appleton4, Richard K Simons1,2, David C Evans1,2,S Morad Hameed1,2, Jack Taunton5, Kosar Khwaja6, Michael O’Connor7, Naisan Garraway1,2, Peter Hennecke3,Donna Kuipers4, Tracey Taulu1 and Lori Quinn4AbstractBackground: The mobile medical unit/polyclinic (MMU/PC) was an essential part of the medical services to supportill or injured Olympic or Paralympics family during the 2010 Olympic and Paralympics winter games. The objectiveof this study was to survey the satisfaction of the clinical staff that completed the training programs prior todeployment to the MMU.Methods: Medical personnel who participated in at least one of the four training programs, including (1) week-endsessions; (2) web-based modules; (3) just-in-time training; and (4) daily simulation exercises were invited to participatein a web-based survey and comment on their level of satisfaction with training program.Results: A total of 64 (out of 94 who were invited) physicians, nurses and respiratory therapists completed the survey.All participants reported favorably that the MMU/PC training positively impacted their knowledge, skills and teamfunctions while deployed at the MMU/PC during the 2010 Olympic Games. However, components of the trainingprogram were valued differently depending on clinical job title, years of experience, and prior experience in large scaleevents. Respondents with little or no experience working in large scale events (45%) rated daily simulations as the mostvaluable component of the training program for strengthening competencies and knowledge in clinical skills forworking in large scale events.Conclusion: The multi-phase MMU/PC training was found to be beneficial for preparing the medical team for the 2010Winter Games. In particular this survey demonstrates the effectiveness of simulation training programs on teamworkcompetencies in ad hoc groups.Keywords: Mobile medical unit, Medical education, Curriculum, 2010 Vancouver Olympic Winter GamesBackgroundMobile medical units often serve as extensions of mainhealth facilities to reach patients when they are at mostrisk. These high-tech units act as mini-hospitals to providedefinitive life-saving emergency and/or post disaster re-sponse for many needs-based functions, including disasterresponse, large-scale recreational events, support in masscasualties, or replacing lost ambulatory or emergencyroom service capacity in case of emergency departmentclosures [1-5].During the 2010 Vancouver Winter Games, mobile sur-gical services and medical support for athletes and officialswere provided on-site at the Whistler Athlete Village bythe Mobile Medical Unit/Polyclinic (MMU/PC). TheMMU/PC was designed to provide definitive life-savingcare for persons in the event that injury severity, transpor-tation, or weather disruption would prohibit immediate* Correspondence: ross.brown@vch.ca1Trauma Services, Vancouver General Hospital, 855 West 12th Avenue,Vancouver, British Columbia, V5Z 1 M9, Canada2Department of Surgery, University of British Columbia, Vancouver, CanadaFull list of author information is available at the end of the article© 2013 Brown et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.Brown et al. BMC Research Notes 2013, 6:462http://www.biomedcentral.com/1756-0500/6/462triage and transport to larger care facilities as well as toprovide surge capacity in the event of a mass or multi-casualty situation.The MMU is a 15.9-metre tractor-trailer, which canexpand to a 90-square-metre unit with up to 12 beds(Figures 1 and 2). Our configuration included four re-suscitation bay/critical care beds, a single table operat-ing room and two non-monitored holding beds. Theunit was supported with a secondary trailer stockedwith 72 hours worth of medical/surgical supplies andother equipment. The MMU had self-contained back updiesel generators, an O2 concentrator, IMIT connectiv-ity, and lab and diagnostic support services.As these are highly sophisticated and specialized units itis necessary to provide equally sophisticated and special-ized training in order to make the users comfortable andfamiliar with the environment. It has been shown thatsimulation based trainings have demonstrated significantimpact on teamwork competencies such as communica-tion, role clarity, situation awareness and leadership aswell as clinical knowledge and skills [6,7]. An educationframework was established early in the planning processto ensure all medical staff and contractors received hands-on training to prepare for efficient and effective patientcare and flow while working in the MMU. This trainingprogram was coordinated by a joint education committeebetween Canadian Forces Trauma Training Centre (West)(CFTTC (W))a and the Vancouver Coastal Health (VCH)section of Learning and Development at VancouverGeneral Hospital (VGH) with close collaboration from thePublic Health Agency of Canada (PHAC), National Officeof Health Emergency Response Teams (NOHERT) andVancouver Olympic Committee (VANOC).Validation and participant satisfaction studies can helplink field performance to training context [8,9]. The feed-back gained from these measures can be used tosynchronize the training objectives with trainees’ area ofexpertise to make the training “more targeted” [10]. Thepurpose of this study was to survey the satisfaction of theclinical staff that completed the MMU/PC training in at-tempt to assess the impact of the education and trainingprogram provided to health care providers who supportedthe MMU during the Games.MethodsParticipantsA total of 105 medical personnel volunteers and contrac-tors were recruited from within the Province of BritishColumbia and from across Canada to provide the requiredmedical expertise to staff and operate the MMU duringthe 2010 Winter Games. Recruitment advertisements spe-cified qualifications/criteria for selection. Successful appli-cants were credentialed through VGH, VCH, and VANOCprior to enrollment. Experts recruited for participation in-cluded anesthesiologists, general and orthopaedic traumasurgeons, emergency, critical care, and operating roomnurses, and respiratory therapists.Participants were grouped into five 17-person teams.Each team comprised of two trauma/general surgeons,two anesthesiologists, two orthopedic trauma surgeons,four operating room nurses, four critical care nurses, twoemergency nurses, and one respiratory therapist. Eachteam was deployed for a 10 to 14 day rotation to providecare and continued support for the Whistler OlympicVillage Polyclinic.Figure 1 The MMU provided critical and surgical care capability in the Whilster Athletics Village during the 2010 Olympic andParalympic Winter Games.Brown et al. BMC Research Notes 2013, 6:462 Page 2 of 8http://www.biomedcentral.com/1756-0500/6/462Education and training modelMMU participants completed a four-phase education andtraining curriculum prior to deployment in effort to fosterthe performance of a high functioning interdisciplinaryteam. Instruction was provided in collaboration with VGH,CFTTC(W), the Centre for Excellence for Simulation Edu-cation and Innovation (CESEI) at VGH, and the VCHLearning & Development division. Training programs weredelivered between October 2009 and March 2010. Thetraining model included the following phases:Phase 1: weekend trainingIn October 2009, medical personnel attended a 2.5 dayworkshop at VGH. The purpose of this training phase wasto introduce team members to other participants and pro-vide an opportunity to become accustomed to the MMUfacility. During this time all participants were also orien-tated with the triage and delivery structure for how medicalservices were to be provided across all Olympic venues. Aswell they were provided with classroom learning and in-struction to increase their content familiarity with theMMU in order to problem solve potential treatment chal-lenges they may face.Phase 2: web-based modulesFollowing the weekend training seminar, participants com-pleted a series of “mandatory” and elective web-basedlearning modules. Learning modules were distributedthrough CESEI and VCH Learning and Development.Topics included Infection Control Basics (hand hygiene),Central Venous Catheter Care & Maintenance, Safe BloodTransfusion, Workplace Hazardous Materials InformationSystem Basics, VANOC 2010 medical services, Introduc-tion to the Mobile Medical Unit – History and Planning,Summary of Whistler Polyclinic and Mobile Medical Unit,Mobile Medical Unit Orientation to Physical Lay Out andPatient Flow, 2010 Olympic/Paralympic MMU BloodEducation Overview, Transfusion Medicine Services,Introduction to METI Emergency Care Simulator (ECS)and Introduction to METI Human Patient Simulator(HPS). Mandatory learning modules included Blood Trans-fusion and Infection Control Basics (hand hygiene).Phase 3: “just-in time” trainingIn the week prior to deployment, participants completed aseries of simulation training exercises in a mock up MMUin CESEI over the span of 1.5 days. Training included sim-ulations as well as small and large group sessions. CFTTC(W) provided leadership in each exercise. Simulation exer-cises escalated in complexity over time, beginning with: (1)an introduction of team dynamics and trauma protocols;(2) orientation session and familiarization with the mocktrauma bay, OR, Emergency Care Simulator (ECS) andHuman Patient Simulator (HPS); (3) scenario based traumamanagement sessions followed by debriefings; and (4) masscasualty and complex case-based scenarios followed byFigure 2 The Mobile Medical Unit in transport configuration (additional images and information can be foundat: http://www.bcmmu.ca/default.htm).Brown et al. BMC Research Notes 2013, 6:462 Page 3 of 8http://www.biomedcentral.com/1756-0500/6/462debriefings. Simulation exercises were modified based onscenarios learned from previous team experiences consist-ent with a rapid cycle change problem solving philosophy.Phase 4: daily simulation trainingSimulation and training were imbedded into the daily rou-tines for the MMU and polyclinic team. Daily simulationexercises ranged in complexity, beginning with simple casescenarios and moving toward more complex situationssuch as Code Blue simulations in all areas of the WhistlerPolyclinic (eg, Dentistry, Therapy, MRI), a series of out-reach responses in the Whistler Athletes Village, and thecomplex Long-Line Helicopter Evacuation from the eventscene to the MMU. Arrangements were made to run thesesimulations while still conducting the normal operationsof the Polyclinic. All scenarios were executed in “real time”whenever possible with fully integrated communicationswith other participating agencies (eg, event security, skipatrol etc.). An important aspect of the training was theformative debriefings held after each simulation. Thedebriefings allowed learnings to be discussed that builtfurther team confidence within the new environment.Survey of clinical staff satisfaction of thetraining programClinical staff were recruited by e-mail using their contactinformation obtained from the MMU/PC managementoffice database. Inclusion criteria for our study were asfollows: (1) having completed a rotation of at least fourdays serving with the MMU/PC in Whistler during theGames, and (2) having completed at least one of the fourphases of pre-deployment training. All persons who par-ticipated in the preparation or delivery of the MMU/PCtraining programs were excluded from the survey.Participants received a letter of initial contact from thePrincipal Investigator outlining the purpose and proce-dures of the study. Attached to this email they received alink to a secure online survey hosted at FluidSurveys(Chide.it Inc., Ottawa, Ontario).Training assessment surveyAll assessment questions were constructed from focusgroup discussions with MMU/PC staff. Questions werebased on the phases of training that were provided priorto deployment and pilot-tested with MMU/PC staff. Thesurvey was divided into three sections: responses to indi-vidual training phases; responses on overall course satis-faction; and demographic and work-related experienceprofiles. The survey was designed to require approxi-mately 15 minutes to complete and would allow partici-pants to save their progress in the event that the couldnot complete the entire survey in one sitting.Most of the questions were closed-ended, but partici-pants were encouraged to provide additional content inthe event they wished to provide more specific feedback.Close-ended questions followed a five-point Likert scaleranging from very valuable, somewhat valuable, neutral,minimally valuable, and not at all valuable. The surveyalso included open-ended questions in which partici-pants were asked to respond in their own words regard-ing the quality and amount of simulation training thatwas provided, whether they have since implemented orincorporated any of the learning approaches into prac-tice at their home hospital/agency, and whether they hadany other comments or suggestions regarding the educa-tion and training that they received during the MMU/PC training period. The survey was posted on-line be-tween May 20, 2011 and August 8, 2011. The study wasapproved by the Behavioral Research Ethics Board at theUniversity of British Columbia.Statistical assessmentDescriptive statistics and cross-tabulations were calcu-lated for each survey item. Responses were stratified byclinical job title, years of experience, and prior experi-ence working in large scale events. Differences betweenmeans of continuous variables were examined using atwo-tailed t-test, and differences in proportions of cat-egorical variables were examined using a chi square test.We examined all categorical variables where expectedvalues were less than five using Fisher’s exact test. A sig-nificance level of 0.05 was used to assess all bivariate re-lationships. All statistical analyses were generated usingSAS software, Version 9.2 for Windows [11].ResultsOf the 94 participants that were contacted, 64 com-pleted the on-line survey (68%). The average age of par-ticipants was 44 years (range 28 to 64). Table 1 lists thestudy population by clinical role. The average numberof years of prior clinical experience for all participantswas 15 years (range 0.5 – 39). The percentage of partici-pants with prior experience working at large scale eventswas 55%. A total of 11 participants had previous militarytraining in health care. All personnel with military traininghad pervious experience working in large-scale events,which included conflict and disaster response tours inBosnia-Herzegovina, Afghanistan, and Haiti. Participantswere similar in years of clinical work experience (χ2 =0.0703, p = 0.791, df = 1), but their characteristics variedwhen comparing the number of participants that had priorexperience working in large scale events (χ2 = 7.4006, p =0.006, df = 1) (Table 2).Training phase 1: weekend trainingSummary statistics for the weekend training are listed inTable 3. On average, all participants rated the training cur-riculum favorably (average curriculum score: 1.70). AreasBrown et al. BMC Research Notes 2013, 6:462 Page 4 of 8http://www.biomedcentral.com/1756-0500/6/462of least interest by all participants included discussion ondaily routines, shifts, and schedules [nursing and RT re-sponse average: 2.00 (SD 1.05); physician staff responses:2.36 (SD 1.05)] and discussion section on uniforms, secur-ity, and accommodation [nursing and RT staff responseaverage: 1.86 (SD 1.11); physician response average: 2.04(SD 1.09)]. No significant differences in response patternsbetween nursing and RT staff and physician staff were ob-served. Responses to the entire weekend training curricu-lum were similar among clinical personnel when contrastedagainst years of work experience and among respondentshaving previous training in large scale events (tablenot shown).Training phase 2: web-based trainingSummary statistics for the web-based training are listed inTable 4. On average all participants rated the web-basedtraining favorably, although less favorable than the Phase1 weekend training (average web-based training score:2.04). When compared against clinical role, nurses andRT’s reported more favorably to Safe Blood Transfusion[1.89 (SD 0.99) vs. 2.42 (1.07); p 0.043], ECS training [1.68vs. 2.50; p 0.007], and HPS training [1.82 vs. 2.38; p 0.008].Training phase 3: just-in-time trainingOn average all participants rated the just-in-time trainingphase favorably (average score excluding blood banksession: 1.59). Comparison statistics for the just-in-timeMMU training are listed in Table 5. When comparedagainst clinical role, nurses and RT’s reported more favor-ably to the simulation training that emphasized competen-cies and knowledge in clinical skills [1.44 (SD 0.58) vs. 2.56(1.23); p 0.002]. On average, respondents without past ex-perience working in large scale events similarly respondedmore favorably to the simulation training exercises that em-phasized competencies and knowledge in clinical skills[1.60 (SD 0.87) vs. 2.33 (SD 1.18); p 0.009]. Responses tothe just-in-time training curriculum were similar amongclinical personnel when contrasted against years of workexperience.Training phase 4: daily simulation trainingSummary statistics for the daily simulation training arelisted in Table 6. On average the daily simulation trainingphase was rated by all participants as the most favorablephase (average score: 1.24). When compared against clin-ical role, neither nurses and RT’s nor physicians differed intheir responses to the simulation training curriculum, withboth groups reporting favorable experiences on each ofthe three simulation components conducted during theMMU/PC training period. No differences in responsefeedback were observed among participants with past ex-perience working in large scale events or among clinicalpersonnel with different years of work experience.Open-ended responsesOn average, both groups responded favorably to thesimulation training. Approximately 55% of physicians(n = 10) who elected to provided feedback felt that theyreceived adequate simulation training prior to deploy-ment, while 39% of physicians (n = 7) recommended thatsimilar training schedules should be increased if thecourse were to be offered again. The most common ra-tionale for providing more simulation training amongphysicians was to improve familiarity working in theMMU unit. Among nurses and RT’s who elected to com-ment on the quality and amount of simulation training,44% (n = 7) felt that the quality and amount of training wassufficient while 47% (n = 9) suggested that more simulationtraining would have been beneficial. The most common ra-tionale for providing more simulation training amongnurses and RT’s was to improve familiarization and move-ment within the MMU.Only 5 of the 34 nursing and RT staff participants electedto provide additional feedback regarding whether they hadimplemented or incorporated any of the learning ap-proaches into practice at their home hospital/agency. Ofthose responses, each participant reported favorably thatthe training has positively impacted their daily routine, butdid not elect to comment on a particular component ofthe training that they found to be beneficial. One individualTable 1 Clinical profile of participantsClinical role N %Nurses and RT’s* 34 53.1Critical care nurse 14 21.9Emergency nurse 6 9.4Operating room nurse 10 15.6Respiratory therapist 4 6.3Physician 30 46.9Anesthesiologist 12 18.8Emergency physician 1 1.6Orthopedic surgeon 6 9.4Trauma surgeon 11 17.2*Respiratory Therapists.Table 2 Clinical experience profileClinical experience Nurses and RT’s* Physicians P valueOverall work experience 0.791< 5 years 8 6> 5 years 26 24Large scale work experience 0.006No experience 10 19Prior experience 24 11*Respiratory Therapists.Brown et al. BMC Research Notes 2013, 6:462 Page 5 of 8http://www.biomedcentral.com/1756-0500/6/462reported that the MMU/PC simulation training has im-proved their team debriefing following regular simulatortraining sessions at their own hospital/agency. Two indi-viduals reported that they now regularly incorporate simu-lation training with their students/staff as a result of thetraining provided at the MMU/PC.DiscussionTo assess the applicability of medical training in the actualpractice field, the impact of training should be questionedin several territories such as clinical skills, performing pro-cedures, patient management, ethicolegal responsibilities,team performance and communication skills [12,13]. OurTable 3 Responses to the weekend training session among nursing and physician course participantsAverage response* Average responses by clinical roleNo. Questions All participants Nurses and RT’s§n = 21 (SD)Physiciansn = 22 (SD)P value1 Training valuable for experiences during the games 1.43 (0.63) 1.43 (0.75) 1.43 (0.51) 0.5202 Training increased comfort and familiarity in work environment 1.48 (0.50) 1.43 (0.51) 1.54 (0.51) 0.5473 Preparation for subsequent practice during the games 1.56 (0.55) 1.52 (0.60) 1.60 (0.50) 0.4374 MMU ’walk through’ provided situational awareness 1.27 (0.59) 1.24 (0.43) 1.32 (0.72) 1.0005 MMU ’walk through’ increase anxiety 4.02 (1.01) 3.9 (1.04) 4.13 (0.99) 0.4556 Discussion seminar on medical liability 1.78 (0.69) 1.67 (0.73) 1.90 (0.64) 0.3567 Discussion on care management of elite athletes 1.63 (0.80) 1.48 (0.60) 1.80 (0.95) 0.2888 MMU ’walk through’: understanding role and procedures 1.46 (0.67) 1.57 (0.81) 1.36 (0.49) 0.8099 MMU ’walk through’: movement of simulated patient 1.45 (0.63) 1.50 (0.69) 1.41 (0.59) 0.89610 MMU ’walk through’: experience in physical layout 1.38 (0.58) 1.40 (0.60) 1.36 (0.58) 1.00011 Discussion on uniforms, security, and accommodation 1.95 (1.09) 1.86 (1.11) 2.04 (1.09) 0.79312 Discussion on daily routines, shifts, and schedules 2.19 (1.05) 2.00 (1.05) 2.36 (1.05) 0.33413 Discussion on protocols, safety, and infection control 1.72 (0.88) 1.67 (0.66) 1.77 (1.07) 0.19914 General Q & A discussion 1.69 (0.75) 1.52 (0.68) 1.86 (0.79) 0.35715 Discussion on mass casualty and emergency planning 1.72 (0.70) 1.57 (0.68) 1.86 (0.71) 0.40816 Discussion on pandemic planning and H1N1 1.86 (0.83) 1.71 (0.64) 2.00 (0.97) 0.73017 Discussion on blood administration protocols 1.76 (0.96) 1.42 (0.51) 2.09 (1.18) 0.10918 Discussion on patient transfer protocols 1.58 (0.76) 1.57 (0.51) 1.59 (0.96) 0.215§Respiratory Therapists, *Response scoring scale: 1 = very valuable, 2 = somewhat valuable, 3 = neutral, 4 = minimally valuable, 5 = not at all valuable.Table 4 Responses to the web-based training seminar among nursing and physician course participantsAverage response* Average responses by clinical roleNo. Questions All participants Nurses and RT’s§ n = 21 (SD) Physicians n = 22 (SD) P value1 Infection control basics 2.31 (1.01) 1.93 (0.70) 2.65 (1.12) 0.0542 Central venous catheters care & maintenance 2.44 (1.16) 2.08 (0.91) 2.75 (1.27) 0.2963 Safe blood transfusion 2.16 (1.08) 1.89 (0.99) 2.42 (1.07) 0.0434 WHMIS basics 2.35 (0.97) 2.18 (0.98) 2.52 (0.95) 0.2545 VANOC medical services 1.85 (0.72) 1.81 (0.79) 1.89 (0.67) 0.4166 Introduction to MMU: history and planning 1.71 (0.75) 1.61 (0.75) 1.80 (0.76) 0.3157 Summary of Whistler polyclinic and MMU 1.66 (0.76) 1.57 (0.69) 1.75 (0.83) 0.3128 MMU orientation to physical layout and patient flow 1.76 (0.90) 1.81 (0.79) 1.71 (1.01) 0.6159 Olympics/paralympics MMU blood education overview 2.07 (1.04) 1.68 (0.72) 2.46 (1.17) 0.07510 Transfusion medicine services 2.07 (0.84) 1.81 (0.78) 2.31 (0.85) 0.17111 Introduction to METI Emergency Care Simulator (ECS) 2.06 (1.03) 1.68 (0.80) 2.50 (1.10) 0.00712 Introduction to METI Human Patient Simulator (HPS) 2.10 (0.96) 1.77 (0.81) 2.48 (0.99) 0.00813 Value in post-test assessments of learning modules 2.09 (0.98) 1.82 (0.81) 2.38 (1.06) 0.329§Respiratory Therapists, *Response scoring scale: 1 = very valuable, 2 = somewhat valuable, 3 = neutral, 4 = minimally valuable, 5 = not at all valuable.Brown et al. BMC Research Notes 2013, 6:462 Page 6 of 8http://www.biomedcentral.com/1756-0500/6/462multi-phase MMU/PC training, that covered a diversearray of areas, was found to be beneficial in the perspec-tive of the participants for preparing personnel for the2010 Winter Games. The uniqueness of this training pro-gram was a four-phase education and training curriculumdesigned to foster the performance of a high functioninginterdisciplinary team.Although our evaluation did not include a controlledclinical trial design, it provides valuable information onthe perspective of clinical staff that completed the differenttraining models developed for the curriculum. In particu-lar this survey demonstrates strong support for incorpor-ating simulation training when preparing ad hoc clinicaltraining programs. These findings add additional supportto the literature on the utility of simulation training pro-grams on teamwork competencies [14]. The study alsoprovides new information on how to structure trainingprograms for preparing clinicians to work within mobilemedical environments.We had a favorable response rate and good representa-tion of among the clinical professionals who participatedin this training program. Over 75% of the participants hadmore than 5 years work experience and 55% had experi-ence working in large scale events, indicating that theWhistler Olympic Village recruitment strategy specificallytargeted individuals with experience working in large-scaleevents and experience in trauma. The fact that the ‘moreexperienced’ groups rated the training favorably does pro-vide an indication that the structure of the training pro-gram was useful and of benefit to the participants.This feedback is important given the many potential situ-ations where ad hoc clinical teams might form, from po-tential epidemic outbreaks, to terrorist threats, to naturaldisasters. Since the 2010 Games, daily simulation has be-come a standing operation procedure for current MMUdeployments in effort to keep our new and constantlychanging teams up to speed on working in these types ofclinical environments. Subsequent deployments haveranged from staging at small stage events, including theBMX Supercross World Cup in Abbotsford, BC in 2012,to outreach programs across the province, to providingEmergency Department support over a 10-day period dur-ing the 2012 flooding of the Surrey Memorial Hospital.Many of the original teaching staff attached to the MMUduring the 2010 Games subsequently became staff for theMMU as a provincial resource. We continue to build onthe original ‘just in time’ training curriculum to help trainand prepare the medical teams prior to deployment. Theseongoing sessions are helping to re-shape the curriculum,taking lessons learned from previous deployments and im-mediately updating lesson plans and performanceobjectives.At the time of the Games, we had little experience in theMMU. Knowing what we do now about the strengths andweaknesses of the unit and support trailer and from experi-ence with the Games and other deployments we would rec-ommend holding more simulation exercises of casualtiesfor future training sessions. In addition, to optimize learn-ing for all clinical staff we would have the MMU wired forvideo broadcast of simulations. We recently did this atTable 5 Responses to the just-in-time MMU training seminar among nursing and physician course participantsAverage response* Average responses by clinical roleNo. Questions All participants Nurses and RT’s§n = 21 (SD)Physiciansn = 22 (SD)P value1 Effectiveness of the introductory session 1.46 (0.58) 1.52 (0.58) 1.40 (0.58) 0.6942 Simulation training: competency & communication 1.40 (0.80) 1.41 (0.69) 1.40 (0.92) 0.3443 Simulation training: knowledge 1.62 (0.89) 1.30 (0.48) 1.95 (1.12) 0.0754 Simulation training: clinical skills 1.98 (1.09) 1.44 (0.58) 2.56 (1.23) 0.0025 Value of simulation training for weekend training session 1.45 (0.77) 1.38 (0.64) 1.54 (0.91) 0.2836 Value of simulation training for web-based training session 1.67 (0.99) 1.63 (0.97) 1.71 (1.04) 0.5257 Value of blood bank training session† 1.65 (0.89) -- -- --§Respiratory Therapists, *Response scoring scale: 1 = very valuable, 2 = somewhat valuable, 3 = neutral, 4 = minimally valuable, 5 = not at all valuable, †Course providedfor nursing staff only.Table 6 Responses to the daily simulation training sessions among nursing and physician courseAverage response* Average responses by clinical roleNo. Questions All participants Nurses and RT’s§ n = 21 (SD) Physicians n = 22 (SD) P value1 Patient moving simulation exercises 1.20 (0.41) 1.21 (0.42) 1.18 (0.39) 0.7592 Long line helicopter simulation exercises 1.28 (0.71) 1.15 (0.36) 1.39 (0.90) 0.3613 Simulation debriefing sessions 1.24 (0.62) 1.17 (0.38) 1.30 (0.77) 1.000§Respiratory Therapists, *Response scoring scale: 1 = very valuable, 2 = somewhat valuable, 3 = neutral, 4 = minimally valuable, 5 = not at all valuable.Brown et al. BMC Research Notes 2013, 6:462 Page 7 of 8http://www.biomedcentral.com/1756-0500/6/462an emergency medical conference, allowing hundreds ofpeople to watch the small teams function in the unit. Foreducation and training purposes, the benefit of the videostream would be the increased observation opportunitiesfor clinical staff as they watched teams practice, thus afford-ing another opportunity to gain experience for workingwithin the MMU.These results should be viewed within the context ofsome important limitations. Firstly, although the surveyresponses imply that the training program developed forthe 2010 Games was effective, we do not present any clin-ical outcome data that can additionally confirm or denythe appropriateness of the training. Access to this datawas not feasible due to ownership and privacy stipulationsof the medical records for all persons treated in the MMUduring the 2010 games. One approach for future trainingevaluation programs would be to hold pre and post train-ing surveys, thereby linking the training and performanceobjectives to outcome measures such as patient satisfac-tion, complications, or functional outcomes. Similarly,future assessments could be derived using pre- and post-test knowledge and confidence tests and surveys followedby post-deployment validation surveys. For example, anexternal reviewer observing team performance for errorrates with simulation patients and treatment algorithms.ConclusionOne of the legacy goals of the MMU/PC is to maintain anannual clinical training program whereby portions of thetraining delivered during the 2010 Winter Games will bereplicated. Within a Canadian context, British Columbia isthe only province with this type of service facility. Thus,it offers an opportunity to improve the preparedness ofCanadian clinical personnel who may later work in austereenvironments either in Canada or abroad. The level of sat-isfaction from participants of the training program isencouraging as it provides a foundation to structure futuretraining clinical training programs for working in MMUenvironments.EndnoteaCFTTC(W) contribution with the permission of theMinister of National Defense.Competing interestsDRB, LA, and PH were employed by the British Columbia Health Authority tostaff the MMU during the 2010 Olympic Winter Games. All other authorsdeclare that they have no competing interest.Authors’ contributionsDRB conceptualized the idea for this study and led in the drafting anddevelopment of the manuscript. BH and NB conducted the statisticalanalyses, created the tables, and drafted an early version of the manuscript.All authors participated in the drafting of the survey questions and in thewriting of the initial and final versions of the manuscript.Author details1Trauma Services, Vancouver General Hospital, 855 West 12th Avenue,Vancouver, British Columbia, V5Z 1 M9, Canada. 2Department of Surgery,University of British Columbia, Vancouver, Canada. 3Provincial Health ServicesAuthority, Vancouver, Canada. 4Vancouver Coastal Health, Vancouver, Canada.5Division of Sports Medicine, Faculty of Medicine, University of BritishColumbia, Vancouver, Canada. 6Trauma Services, McGill University HealthCenter, Montreal, Canada. 7Department of Emergency Medicine, University,Kingston, Ontario, Canada. 8College of Nursing, University of South Carolina,Columbia, USA.Received: 3 September 2013 Accepted: 8 November 2013Published: 13 November 2013References1. Bolster C: Mobile hospital provides care when disaster strikes.Healthc Financ Manage 2006, 60:114–116.2. Blackwell T, Bosse M: Use of an innovated design mobile hospital in themedical response to hurricane katrina. Ann Emerg Med 2006, 49:580–588.3. King B, Jatoi I: The mobile army surgical hospital (MASH): a militaory andsurgical legacy. J Natl Med Assoc 2005, 97:648–656.4. Erich J: As good as advertised: mobile hospital shines in Katrinaresponse. Emerg Med Serv 2007, 36:38–39.5. Hoffman H: Medical field hospital capability and trauma care. J Trauma2007, 62(6 Suppl):S97–S98.6. DeVita M, Schaefer J, Wang H, Dongilli T: Improving medical emergencyteam (MET) performance using a novel curriculum and a computerizedhuman patient simulator. Qual Saf Health Care 2005, 14:326–331.7. Shapiro M, Morey J, Small S, Langford V, Kaylor C, Jaminas L, et al:Simulation based teamwork training for emergency department staff:does it improve clinical team performance when added to an existingdidactic teamwork curriculum? Qual Saf Health Care 2004, 13:417–421.8. Goldie J: AMEE education guide no. 29: evaluating educational programs.Med Teach 2006, 28:210–224.9. Canadian Forces Individual Training & Education System: CFITES Manualof Individual Training and Education. http://www.admfincs-smafinsm.forces.gc.ca/dao-doa/5000/5031-2-eng.asp.10. Salas E, Rosen M, Burke C, Nicholson D, Howse W: Markers for enhancingteam cognition in complex environments: the power of teamperformance diagnosis. Aviat Space Environ Med 2007, 78:B77–B85.11. SAS Institute Inc: SAS/STAT® version 9.2 of the SAS system for Windows. Cary,NC, USA: Copyright © 2008.12. Buljac-Samardzic M, Dekker-van Doorn C, van Wijngaarden J, van Wijk K:Interventions to improve team effectiveness: a systematic review.Health Policy 2010, 94:183–195.13. Mukhopadhyay S, Smith S: Outcome-based education: principles andpractice. J Obstet Gynaecol 2010, 30:790–794.14. Mencia S, Lopez-Herce J, Botran M, Solana M, Sanchez A, Rodriguez-NunezA, Sanchez L: Evaluation of advanced medical simulation courses fortraining of paediatric residents in emergency situations. Anales dePediatria 2012, 78:241–247.doi:10.1186/1756-0500-6-462Cite this article as: Brown et al.: Creating a gold medal Olympic andParalympics health care team: a satisfaction survey of the mobilemedical unit/polyclinic team training for the Vancouver 2010 wintergames. BMC Research Notes 2013 6:462.Brown et al. BMC Research Notes 2013, 6:462 Page 8 of 8http://www.biomedcentral.com/1756-0500/6/462

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