ASPiH 2022 Conference – All things being equitable: Diversity, inclusion, and simulation

Building upon the use of simulation to improve systems, as considered during last year’s conference

The simulation community has been attentive to the issues raised and must not shy away from exploring deeper these underlying issues that may impair adequate care. Sensitive to this need, diversity and inclusion are the themes of this year’s Association for Simulated Practice in Healthcare (ASPiH) annual conference. Many abstract submissions show how these topics can be meaningfully incorporated within simulation activities, scenario design, debriefings, and are applicable to various simulation modalities

But diversity and inclusion are also highly relevant with regards to our colleagues in the clinical setting as well as within our simulation circle. We need to consider our own educational community of practice by being role models in terms of diversity and inclusivity. We hope to see a very diverse and inclusive groups of delegates attending the 2022 ASPiH Conference in Birmingham, 6-8

Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference. Thank you also to all the reviewers involved in the selection process as we couldn’t run the conference without you. Now is the time to start thinking about your contribution for next year!

1. Moneypenny M, Weldon SM, Hamilton C, Buttery A, Alinier G. ASPiH 2021 Conference–Moving upstream: using simulation to improve systems. International Journal of Healthcare Simulation. 2022;1(1):1–2.

2. Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y, Meltzer AC. Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. The American journal of emergency medicine. 2019;37(9):1770–7.

3. Drabish K, Theeke LA. Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: a systematic review of quantitative studies. Issues in mental health nursing. 2022;43(2):111–8.

4. Knickle K, Weir K, McNaughton N. Authoring and othering: examining bias in scenario design. International Journal of Healthcare Simulation. 2021;1(1):45–8.

5. Bignell A, Baxey E, Saunders A, Ortega-Vega M. Reducing Restrictive Practices- Using simulation education to tackle mental health stigma. International Journal of Healthcare Simulation. 2022. doi: 10.54531/WCNV4657 (In this current special issue)

6. Welsh H, Clay G, Fisher M, Ortega-Vega M, Virk K, Evans G. The Power and Influence of the Theatre on Immersive 360° Videos. International Journal of Healthcare Simulation. 2022. doi: 10.54531/CRTF6001 (In this current special issue)

7. Wadsworth J, Blair J, Millett R, Damberg K, Esposito M, Van Vuren E, Marshall E. Using a systems-based approach to explore the enablers and barriers to equality, diversity, and inclusion within a simulation-based education service. International Journal of Healthcare Simulation. 2022. doi: 10.54531/INKE9149 (In this current special issue)

8. Paul O, Connor DB. Fostering diversity in healthcare simulation. International Journal of Healthcare Simulation. 2022 Jul 29(null):1–2.

9. Kulkarni S, Tsigerides J, Sule Medha. Walk in Their Shoes - Immersive 360-degree VR experience of Diversity and Inclusivity in the NHS. International Journal of Healthcare Simulation. 2022. doi: 10.54531/LADH8978 (In this current special issue)

10. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(1):1–8.

11. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare. 2021;16(4):275–84.

Perioperative FLOT plus anti-PD-L1 avelumab (FLOT-A) in resectable oesophagogastric adenocarcinoma (OGA): Interim safety analysis results from the ICONIC trial

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Background: ICONIC is a single-arm phase II trial investigating the safety and efficacy of perioperative FLOT-A in resectable OGA. Following a 3+3 design safety run-in phase, standard dose FLOT with 10mg/kg IV avelumab (dose level 0) q2weeks was taken forward into the main study. The aims of this pre-planned interim analysis were to assess perioperative safety and R0 resection rates. Methods: The interim analysis occurred once the 15th patient treated at dose level 0 reached 30 days post-surgery. Results: At data cut-off, 15 patients had received at least one cycle of FLOT-A and had undergone resection. The median age of patients was 63y (range: 25 – 73). 71% had an ECOG PS of 0. 60% of tumours were staged as T3 at baseline and 40% T2; 67% were N0, 7% N1 and 27% N2. Due to 5-FU related cardiac toxicity, two patients switched to alternative chemotherapy without 5-FU and avelumab. 13/15 patients (87%) completed 4 cycles of pre-operative FLOT-A; of these, five patients had avelumab omitted for one cycle for toxicity evaluation and management. 9/15 patients (60%) experienced a G3/4 adverse event (AE). These were FLOT-A-related in 8/15 patients (53.3%). The commonest G3/4 AEs were febrile neutropenia, neutropenia and diarrhoea. Median time from last chemotherapy to surgery was 6.4 weeks. No delays or failure to proceed to surgery occurred due to avelumab-related complications. 7% of patients had an American Society of Anaesthesiologists (ASA) preoperative risk score of I, 47% a score of II and 47% a score of III. 73% of patients had operations involving a thoracic approach (10 minimally invasive Ivor-Lewis oesophagogastrectomy with two field radical lymphadenectomy, 1 left thoracoabdominal oesophagogastrectomy and 4 gastrectomy with D2 lymphadenectomy). Median time to extubation was 6h (IQR: 4-24). The median Acute Physiology and Chronic Health Evaluation (APACHE) score at day 1 post-op was 12 (IQR: 10-15) with a median of 3 days (IQR: 2-4) of CCU care. No unexpected complications were reported intra-operatively or during post-operative recovery in FLOT-A treated patients. 5/14 evaluable patients at data cut-off (35.7%) had Clavien-Dindo grade II post-operative complications and 3/14 (21.4%) grade IIIa complications; of these 1 patient had an anastomotic leak that was treated endoscopically. There were no emergency re-operations. All 15 patients achieved R0 resections and were discharged home after a median of 13d (IQR: 11-16) in hospital. Conclusions: To date, FLOT-A has not led to unexpected or unusually severe perioperative complications in the context of major complex upper GI surgery for resectable OGA. Clinical trial information: NCT03399071.

It's okay to talk: suicide awareness simulation

BACKGROUND

Doctors are at an increased risk of suicide compared with the general population, and there is a current lack of formal education on suicide prevention for peers and colleagues. This educational project aimed to increase suicide awareness for medical students through simulation.

METHODS

A simulation scenario was designed centred around a junior doctor (a qualified doctor who has not yet completed specialist postgraduate training) disclosing thoughts of suicide. The scenario and debriefing were designed using learning objectives and constructive alignment theory. Senior medical students participated in the scenario, which was followed by a facilitated debriefing and the provision of a framework for discussing suicide with a colleague. Quantitative and qualitative student feedback was collected and analysed. A simulation scenario was designed centred around a junior doctor colleague found distressed at work and disclosing thoughts of suicide RESULTS: A total of 35 students participated in the simulation over six sessions. Feedback indicated that students felt this subject was important and that the learning objectives had been achieved.

DISCUSSION

This simulation scenario focusing on suicide awareness for senior medical students has provided opportunity for open discussion and reflection on the topic and has increased the awareness and understanding of suicidality in colleagues. This is one step in the direction of preventing further deaths by suicide in health professionals.