The Facilitator's Role in London's Air Ambulance's Simulation “Moulage” Training

doi:10.1016/j.amj.2014.12.012

Air Medical Journal

Volume 34, Issue 2, March–April 2015, Pages 92-97

https://doi.org/10.1016/j.amj.2014.12.012 Get rights and content

Abstract

Objective

This research focused on the facilitator's role in the simulated patient training “moulages” used by London's Air Ambulance (LAA) for their team training. Facilitators are chosen based on their experience and expertise in the field. The aim of this research was to gain insight into the role of moulage facilitator.

Methods

An ethnographic approach was employed, using the notion of “progressive focusing.” Overt observational fieldwork was performed, with the resulting field notes evaluated by content analysis. Semistructured interviews were then conducted with 8 facilitators selected by convenience sampling in order to gain an understanding of the role according to their perspective.

Results

The research revealed the role of the facilitator to be challenging and multifaceted. The moulage process appeared appropriate to its function, and the facilitation methods were largely in accordance with recommended practice outlined in educational literature.

Conclusions

The London's Air Ambulance moulage facilitators have to prepare trainees for an intense and emotionally demanding job. Their methods are derived from experience, often with a subconscious application of sound educational practice. This research may help the team identify certain areas with scope for further refinement including feedback methods, fidelity, and reducing the burden of multitasking.

Section snippets

Study Design

The LAA is a highly specialized and understudied group of professionals. An ethnographic study approach was used, including the notion of “progressive focusing,”² in which the process of inquiry involves a gradual clarification of the research question. To achieve this, observational field work was followed by in-depth interviews.

Setting and Participants

Ethnography is described as “the art and science of describing a human group,”³ and this was the key objective here. The LAA provided the observers with full access to

Purpose

The researchers gained a deeper understanding of the role of a moulage facilitator through 1-to-1 interviews. The choice of questions was informed by the findings of the observational work. Combining interviews with observational data helped understand the meaning behind the observed behaviors.

Sampling and Process

Eight team members who regularly facilitated were interviewed on an ad hoc basis using convenience sampling. Two paramedic and 3 doctor facilitators were interviewed. The interviews were recorded and

Results and Discussion

The key themes that emerged from the observational work and interviews are discussed with supporting excerpts. The true value of the interviews was realized when the interviewees explained the meaning behind observed actions and behaviors.

Timing of Feedback

Feedback was used by the facilitators both during (intrinsically) and after (extrinsically) the moulage.⁷ Through intrinsic feedback, the facilitators could evaluate the understanding of the learners. This was a dynamic and informal process that went hand in hand with the teaching. The field work revealed that the use of intrinsic feedback noticeably declined as the course progressed; however, the occurrence of extrinsic feedback did not fluctuate. The gradual decline in the need for intrinsic

Standardization

Standardization is seen as an important benefit of simulation.¹¹ During an introductory seminar, participants were taught about the standard operating procedures (SOPs) to apply to upcoming moulages. This is endorsed by 1 interviewee.

“It should be when you facilitate you're running it the same for everybody” (doctor 3).

During 1 briefing session, the facilitator encouraged a discussion among the learners regarding the SOPs for treating a severe asthma attack.

LAA doctor facilitator tells learners

Scenario Development

In addition to running the moulages, senior facilitators have the role of scenario development. The observations and interviews revealed some important considerations.

Before the start of each moulage, the facilitator(s) briefed the participants (including any actors involved) and assigned roles. Contrary to recommendations in the literature,¹⁶ the learning outcomes were not mentioned until after the scenario had finished. There appeared to be a notion of “learning by doing” within the LAA, that

Summary

Overall, the observational work helped to develop the anticipated roles of the moulage facilitator. Furthermore, the incredibly complex nature of the facilitators' job was revealed to the researchers. The interviews provided the researchers with a valuable insight into the meaning behind what was silently observed. This greatly aided the researchers in developing a deep understanding of what it means to be an LAA moulage facilitator.

Conclusion

Based on what emerged from spending time immersed in their culture of training, Figure 2 shows the varying roles of an LAA moulage facilitator. Effective facilitators not only need to be experienced in their field, but they should also have the attributes of a good teacher. In this particular study, the ability to multitask was considered as particularly important by the facilitators.

Steinert²⁴ recommends that, after understanding the culture of the organisation, a thorough needs assessment

Acknowledgments

The authors would like to thank and acknowledge London's Air Ambulance for allowing unrestricted access to their training methods.

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Original ResearchThe Facilitator's Role in London's Air Ambulance's Simulation “Moulage” Training

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study Design

Setting and Participants

Purpose

Sampling and Process

Results and Discussion

Timing of Feedback

Standardization

Scenario Development

Summary

Conclusion

Acknowledgments

Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

Scand J Trauma Resusc Emerg Med

Evaluation as illumination: a new approach to the study of innovative programmes

Evaluation Studies Review Annual

Doing Interviews

Simulation in medical education

Giving feedback in medical education: verification of recommended techniques

J Gen Intern Med

Formative assessment

Self-discrepancy: a theory relating self and affect

Psychol Rev

Use of SPRAT for peer review of paediatricians in training

Br Med J

The challenges of initiating in a multiprofessional clinical skills project

Journal of Interprofessional Care

Original Research
The Facilitator's Role in London's Air Ambulance's Simulation “Moulage” Training