Lund, Sweden

About In-Situ Procedural Training

Clarity in Emergency Medicine

The ability to perform procedures under time pressure is a core competence in Emergency Medicine [1, 2]. Educators who strive to ensure that all residents and specialists in an Emergency Medicine program master key procedures face four challenges:

  1. In order to acquire and maintain procedural competence, emergency physicians need to regularly practice these procedures. Ensuring that all members in a program regularly perform procedures is logistically challenging, especially when it comes to procedures that are seldom performed in clinical practice.

  2. Being able to perform a procedure in a crisis situation includes the ability to find and use local equipment. The implication is that procedural training ought to include an in-situ component.

  3. Most procedures are performed by several team members working together, not simply by the emergency physician performing all steps him- or herself. For example, chest tube insertion is usually carried out by a physician and nurse working together. The implication is that procedural training should optimally be carried out in a multi-disciplinary setting, further complicating the logistical challenges of procedural training.

  4. Procedures cannot be practised in thin air. Models representing specific body parts are required, and the more realistic the model, the more valuable the training.

To address the first three challenges, Lund’s Emergency Department started a project in February 2019 whereby multidisciplinary teams that take care of priority 1 patients meet in the resuscitation bay every morning during week-days and perform one procedure, according to five generic steps:

  1. Fetching the training material (located in procedure-specific boxes in a closet in the ambulance bay)

  2. Locating, in the resuscitation bay, the procedural equipment that would be used in clinical practice

  3. Carrying out the procedure using a blend of actual procedural equipment, training equipment that is identical to the actual equipment, and training models

  4. Registering the time taken to carry out the procedure according to a predetermined checklist

  5. Replacing used training material and restoring the material in the ambulance bay

Training models have been developed and are undergoing continuous revision. We have aimed to develop models that are sufficiently realistic, cheap to build and easy to maintain. The project addresses one of the European Society for Emergency Medicine recommendations concerning scenario-based training [3].

[1] Härtel C, Prosen G, Brown R, Dryver E. European Core Curriculum for Emergency Medicine. Version 2.0. European Society for Emergency Medicine, 2019 [cited 27 july 2019].

[2] SWESEMs utbildningsutskott. SWESEMs Core Curriculum. I: 10 maj 2016 [cited 01 jan 2019]

[3] Dryver E, Prosen G, Garcia-Castrillo Riesgo L, Dodt C. European Society for Emergency Medicine viewpoint: the decalog of scenario-based training. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2020;27(1):2-4. doi: 10.1097/mej.0000000000000646 [published Online First: 2019/11/26]