Training the trainers: improving the quality of education delivered to paramedics through a simulation-debrief model.

Introduction: Education and training delivered within ambulance services is vital to clinicians maintaining competence, confidence and currency. Simulation and debrief in medical education aims to imitate clinical experience and provide real-time feedback. The South Western Ambulance Service NHS Foundation Trust employs senior doctors in their learning and development (L&D) team to support the development of 'train the trainer' courses for L&D officers (LDOs). This short report of a quality improvement initiative describes the implementation and evaluation of a simulation-debrief model of paramedic education. Methods: A quality improvement design was adopted. The train the trainer scenarios for simulation-debrief were designed and written following the trust's training needs analysis by the L&D team. The course ran for two days, and each scenario was facilitated by faculty experienced in simulation (both doctors and paramedics). Low-fidelity mannequins and standard ambulance training kit was used (including response bags, training monitor and defibrillator). Participants' pre- and post-scenario self-reported confidence scores were recorded, and qualitative feedback requested. Numerical data were analysed, and collated into graphs using Excel. Thematic analysis of comments was used to present qualitative themes. The SQUIRE 2.0 checklist for reporting quality improvement initiatives was used to frame this short report. Results: Forty-eight LDOs attended across three courses. All participants reported improved confidence scores in the clinical topic covered after each simulation-debrief scenario, with a minority reporting equivocal scores. Formal qualitative feedback from participants indicated an overwhelmingly positive response to the introduction of simulation-debrief as an education method, and a move away from summative, assessment-based training. The positive value of a multidisciplinary faculty was also reported. Conclusion: The simulation-debrief model of paramedic education represents a move away from the use of didactic teaching and 'tick box'-style assessments in previous train the trainer courses. The introduction of simulation-debrief teaching methodology has had a positive impact on paramedics' confidence in the selected clinical topics, and is seen by LDOs as an effective and valuable education method.