Evaluation of a novel simulation-based training for urgent laryngectomy care.

backgroundLaryngectomy (removal of the larynx, usually due to cancer) results in significant anatomical changes requiring specific clinical skills to safely manage the airway and support altered communication. It is crucial that healthcare professionals understand how to support people with laryngectomy, particularly in emergency care when their usual healthcare teams will not be present. Provision of laryngectomy training is limited. Existing education approaches fail to fully meet the needs of healthcare professionals, which in turn impacts on the provision of intervention to people with laryngectomy. With increasing evidence for simulation in pedagogical literature, this study explores how this approach can be used to support clinical skill education and improve urgent laryngectomy care. The aim of this study was to establish if a simulation-based approach is a feasible method of enhancing healthcare professional knowledge and confidence to provide emergency care to people with laryngectomy.

methodsA simulation-based training programme was piloted with delegates from a range of healthcare professions, over three separate study days. Immersive simulation scenarios were facilitated within a medical simulation centre using a modified SimMan mannequin, specially created models and prosthetics. Post-simulation debriefings were held with a focus on developing clinical skills within a Human Factors approach. In addition, training incorporated a skills-based session and interactive discussion with expert patients. Training was evaluated using pre- and post-course self-evaluation and qualitative feedback. Feasibility outcomes included the percentage of eligible participants who consented to take part, and the number of participants who completed the training.

resultsTwenty-eight multidisciplinary healthcare professionals registered for the training; 26 (93%) attended and completed the training activities as prescribed. Qualitative data indicated that simulation, debrief and skills practice were all perceived as important training aspects. Participants placed particular value on the simulated resuscitation scenario. Self-assessed composite knowledge scores and individual knowledge-item scores increased significantly post-training (p =  < 0.001-0.04). Reflective of participants' emphasis on resuscitation, knowledge of post-laryngectomy resuscitation requirements increased significantly post-training (p =  < 0.001).

conclusionsSimulation-based training is a feasible method of clinical skill acquisition for urgent laryngectomy care. Further research is needed to assess whether competence is maintained over time, and whether Human Factors learning generalises to clinical practice. Wider study could incorporate assessment of the impact of the training on people with laryngectomy's experiences of urgent care and potential impact on hospital flow.