Ashton White & Associates May 2013 Page 1
Institute of Trauma and Injury Management
Review of Education
Services 2013
Ashton White & Associates May 2013 Page 2
1. Background
The Institute of Trauma and Injury Management (ITIM) has provided a range of education
services over the last decade. Whilst these have varied slightly there has been a core
component that has remained consistent over the period.
At the ITIM workshop in September 2012 there was strong support for ITIM to coordinate
the development of an education plan and for the plan to be informed through a process of
consultation with trauma services.
Other key points raised in the workshop included:
The education role that major centres should have in supporting rural centres
The need for ITIM to develop relationships with the tertiary sector so as to influence
curriculum
A better process for state guidelines was needed
Trauma Team Training was important and valuable
Trauma Assessment Resuscitation and Transport program should be increased in
rural areas
Provision of on-line requirements needs review
The restructure of ITIM with the move into the Agency for Clinical Innovation (ACI) has
included creation of a specific sub-committee of the Research Committee to focus on
education issues. The new ITIM Executive included a review of education as a priority within
the ITIM work plan and as a precursor to the development of an education plan.
2. Approach
The methodology for the review involved four components:
1. Understanding and assessment of what is currently invested in education services:A
pro forma was created to collect information from the last three financial years.
Information collected included the frequency of the activity, the number of
participants, the cost to ITIM and the revenue received. Additional information was
provided via the Sydney Clinical Skills and Simulation Centre (SCSSC) report on the
Australian Trauma Team Training (ATTT) program. The information gained from this
assessment assisted in determining the focus of the questions for the survey and
individual interviews
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2. Survey of trauma system clinicians:A brief survey (Appendix 1) was developed and
endorsed by the ITIM Executive. The sample group for the survey included the
mailing lists of ITIM, The Emergency Care Institute (ECI), and the Intensive Care
Coordination and Monitoring Unit (ICCMU). These mailing lists included pre hospital,
hospital and post hospital personnel. Some further distribution occurred at a local
level. The survey was sent to potential respondents via email with a link to Survey
Monkey (the tool used for administration of the survey). Responses were not
individually identified.
3. Focus Groups:Eight focus groups were held across the State with major centres
inviting referring centres and others with an interest in contributing to the review.
Details of those attending can be found in Appendix 2. The approach was endorsed
by the ITIM Executive and included focus groups at Liverpool, Westmead, Royal
North Shore, John Hunter Hospital (x2), Orange, Wagga Wagga and metropolitan
central Sydney (x2). Structured questions for discussion at the focus groups were
developed and an external consultant was engaged to co-facilitate with the ITIM
Manager and document the outcomes from the focus groups.
4. Individual interviews:Interviews were held with members of the ITIM Executive
(which included the Chairpersons of the Research Committee, the Data Committee
and the Quality Review Committee), ITIM staff and other clinicians that specifically
requested interviews. A structured set of questions was developed and used for all
interviews which were conducted either by telephone or face to face by the
consultant engaged to undertake the review.
3. Results
1. Investment and current activity assessment:
Activities: Six major ITIM education activities were identified over the last three
years. These were: Australian Trauma Team Training (ATTT); Trauma Assessment
Resuscitation and Transport (TART) Program; AIS Injury Scaling and Techniques
course; trauma evening seminars; Clinical conference; head injury guideline
development and Structured Trauma Education Program (STEP). All these activities
required significant ITIM resource (human or fiscal) investment. There are other
smaller education activities that ITIM supports on an ad hoc basis – eg financial
support for local trauma activities.
i. ATTT Program – This program was conducted regularly during each of the years, with
reduced frequency in 2012/13 because of lack of clarity about future priorities. ITIM
Ashton White & Associates May 2013 Page 4
staff costs are detailed separately. The program cost is taken from the annual
allocation to the SCSSC.
2010/11 2011/12 2012/13
frequency 6 (5 adult, 1 paed) 6 (5 adult, 1 paed) 4 (3 adult, 1 paed)
participants 72 72 48
cost $31,800 $31,800 $21,200
revenue Nil Nil Nil
ii. TART Program – this program incorporates a skills day, trauma evening and ATTT
program and is conducted in rural locations. ITIM staff costs are detailed separately.
The program cost is taken from the annual allocation to the SCSSC.
2010/11 2011/12 2012/13
frequency 1 (Lismore) 1 (Orange) 2 (Coffs, Wagga planned)
participants 70 70 70 + 70 expected
cost $10,800 $10,800 $10,800 (to date)
revenue Nil Nil Nil
iii. AIS Course - This course is conducted both as an initial and refresher course. It is the
only course that currently generates income through some degree of subsidisation at
a local level. ITIM is an international provider of this course. ITIM staff costs are
detailed separately.
2010/11 2011/12 2012/13
frequency 5 courses 3 courses 1 completed, 1 planned
participants 37 26 15 + 15 expected
cost $6970 $3040 $5500
revenue $12,150 $6500 $4550
iv. Trauma evenings - These evenings are sponsored and co-ordinated by ITIM and have
very high attendance rates. ITIM staff currently undertake manual registration but
this will be on-line via ACI in the future. ITIM staff costs are detailed separately.
2010/11 2011/12 2012/13
frequency 2 (St G and Randwick)
1 (Rooty Hill) 1 (Hunter)
participants 300 229 108
cost $6092 $7315 $2820
revenue Nil Nil Nil
v. STEP - This development commenced in 2011 and the primary cost is ITIM staff time
which is detailed separately.
2010/11 2011/12 2012/13
frequency n/a 1 1
participants n/a n/a
Ashton White & Associates May 2013 Page 5
cost $3000 (software) n/a
revenue n/a n/a
vi. Clinical conference - This was a one off event which generated a small surplus.
2010/11 2011/12 2012/13
frequency 1 n/a n/a
participants 276
cost $65,600
revenue $69,200
vii. Guideline development - This was a one off event relating to the second edition of
the head injury guideline. Primary cost was ITIM staff time which is detailed
separately.
2010/11 2011/12 2012/13
frequency 1 (head injury) 1 (head injury) n/a
participants n/a n/a
cost n/a n/a
revenue n/a n/a
ITIM staff costs: approximateITIM staff costs directly associated with the above
activities was $32,000 in 2010/11; $45,000 in 2011/12 and $41,000 in 2012/13 (to
end November 2012). This assumes staff member cost to be $400 per day. This does
not take into account non-quantifiable support cost as there has been no record
keeping that demonstrates the true cost of supporting education activities and it
cannot be calculated retrospectively. The real cost would be much higher and was
predominantly in the education position although both the data and quality
positions were also involved in education.
Total education costs:this includes the allocation to the SCSSC and ITIM staff costs
although these are likely to be significantly understated. It would be reasonable to
assume that 1FTE is associated with education activities currently, which suggests an
underestimate of staff cost of around 50%.
2010/11 2011/12 2012/13
SCSSC $96,400 $146,400 TBD
TART and ATT $42,600 $42,600 TBD
Other (minus revenue)
$2668 (-) $6855 $3770
Staff $31,200 $44,800 $40,800
Total $167,532 $240,655
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2. Survey:
Demographics:The total sample number was approximately 2800 and 304 responses
to the survey were received. Of these 9 respondents were from interstate or
overseas. 61% (n=185) of respondents were nurses, 20% (n=60) medical staff and
16% paramedical or allied health professionals.
All respondents identified a primary specialty with the majority identifying
emergency (43%), trauma (13%) and critical care (13%) as the next most common
specialties.
Most respondents had more than 10 years experience (n=191) with only 58 having 5
years or less. 64% (n=38) of medical staff had more than 10 years experience.
Attendance at education events:
154 respondents advised that they had attended education provided by ITIM with 79
respondents advising that they had attended more than one event.
The trauma evenings (n=91) and the ITIM conference (n=79) were identified as the
most popular. 66 respondents attended trauma team training (ATTT) and 17
respondents attended the trauma assessment, resuscitation and transport program
(TART).
0
20
40
60
80
100
120
140
Primary specialty
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Most respondents (n=237) had attended a trauma related education event organised
by their local organisation. 68respondents advised that they had not attended any
local events. Of these respondents, 63 had not attended any ITIM organised events
either.
Trauma related grand rounds, short courses and conferences were attended by
more rural and pre-hospital respondents than by those from metropolitan areas. In-
service lectures were the most popular local education with 186 respondents
advising of their participation. Of these, 51 were rural, 24 pre-hospital and 108
metropolitan.
Trauma courses:180 respondents advised that they had attended a trauma course
delivered by a professional body or university. 50% of respondents were from rural
or pre-hospital areas.
The most popular trauma specific short courses were Early Management of Severe
Trauma (EMST) (n=85), and the Trauma Nursing Core Course (TNCC) (n=80).
0
20
40
60
80
100
120
140
160 N
u m
b e
r
Respondent attendance at trauma education provided by ITIM
Prehopsital
Rural
Metro
Ashton White & Associates May 2013 Page 8
The SSWAHS Trauma Nursing Course, some paediatric specific courses and courses
associated with aeromedical retrieval were also identified as well as some more
generic intensive care courses.
77 respondents advised that they had completed post graduate level trauma courses
with Masters of Critical Care Medicine / Nursing (n= 26) and Masters of Emergency
Medicine / Nursing (n=30) being the most popular. 10 nursing staff advised that they
had completed other relevant post graduate certificates.
ITIM’s role in trauma education:280 responses to this question were received with
most respondents (96%) selecting more than one choice. Delivering clinically
focussed education in collaboration with local clinicians, developing education
content, such as e-learning, in collaboration with expert clinicians and acting as a
portal for information regarding trauma were the strongest supported roles.
0
10
20
30
40
50
60
70
80
90
100
Completed a trauma specific short course provided by professional bodies
Early Management of Severe Trauma (EMST)
Definitive Surgical Trauma Care (DSTC)
Definitive Perioperative Nurses Trauma Care (DPNTC)
Trauma Nursing Core Course (TNCC)
Trauma Nursing Program (TNP)
Pre-Hospital Trauma Life Support (PHTLS)
International Trauma Life Support (ITLS)
Other
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31 respondents provided comments and the focus of these was predominantly
around ITIM being realistic about what it could provide as distinct from what
education could be provided through expertise within the trauma system.
Some respondents suggested that ITIM should focus more on providing financial
support for clinicians to attend courses rather than developing courses.
Specific suggestions included ITIM supporting more allied health input rather than
solely focussing on medical and nursing requirements, supporting more education at
the smaller sites and particularly those that are more remote and in which trauma is
not a common event but needs skilled management when it occurs.
There were mixed views about the value of on-line education (there is already a lot
of on-line resource)
118
93 93
122 109
79
50 60
74
71
21
13 19
20 21
0
50
100
150
200
250
Deliver clinically focussed
education in collaboration
with local clinicians
Support education
delivered by local clinicians
Coordinate education activities
across NSW
Develop education
content, such as for e-
learning, in collaboration with expert
clinicians
Act as a portal for
information regarding
trauma
ITIM's role in education should be...
Pre-hospital
Rural
Metro
Ashton White & Associates May 2013 Page 10
The prioritisation of resource use is shown in the table below (1 = highest priority)
Clinical practice guidelines:95% (n=263) of respondents considered that ITIM should
be involved in updating or developing clinical practice guidelines for state-wide
implementation.
The priority areas are shown in the table below.
Of those identified as other, spinal (n=10) and chest (n=9) were those most
frequently suggested.
40.36%
5.71%
27.86% 26.07%
29.29%
16.07%
28.57% 26.07%
20.71%
32.14%
17.86% 29.29%
9.64%
46.07%
25.71% 18.57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Coordinate the rollout of the Trauma Team Training course into Major and Regional
Trauma Centres
Deliver the AIS Injury Scoring and
Techniques course.
Develop a trauma e- learning course in collaboration with expert clinicians.
Focus more on regional and rural areas such as with
increased delivery of the TART program.
Response Breakdown
4
3
2
1
0
20
40
60
80
100
120
140
160
180
Head Airway Pelvic Shock Other
Priority trauma guidelines for ITIM to develop / update
Ashton White & Associates May 2013 Page 11
ITIM’s role in meeting trauma education needs: 160 responses were received. The
main themes were - provide education about what should be expected of facilities
(n=5); provide more focus on rural/regional facilities (n=19); develop an e-learning
platform and resources (n=39); provide state wide guidelines (n=10); provide
/facilitate local education (n=20); ATTT (n=7); conferences (n=8) and provision of
state wide leadership and governance (n=5).
Further suggestions:Most suggestions related to provision of guidelines, support for
and engagement of clinicians and improved communication
3. Focus Groups
The focus group discussions followed a structured format and the outcomes are
summarised in main response areas.
Locally provided education:
Locally basedTrauma Team Training was being conducted in all the major trauma
centres and some regional centres. The curriculum was based on the SCSSC model
but has been customised locally and a number of the centres were keen to point out
that their courses had a stronger inter-disciplinary focus.
Outreach education was being provided by some major centres and this included
trauma days, road shows and regular visits to referring hospitals. Some centres did
not provide outreach education services citing lack of resources as the primary
reason. Some regional centres had established outreach education programs to the
smaller rural facilities. In most centres the outreach education was supported by
simulation.
A number of centres had established school and community programs, including
public forums, which focussed on injury prevention.
All centres were involved in a variety of local facility programs either specifically for
trauma or by contributing trauma input to other programs. These included
departmental and in-service education, education contributions to medical and
nursing under and post graduate training programs, trauma grand rounds, case
presentations, journal clubs and research meetings.
Local trauma evenings were organised by some centres (a number of centres also
conducted these at referring hospitals). These evenings were inter-disciplinary and in
rural areas, in particular, included ambulance staff and general practitioners.
Local staff were supported to participate in a range of formal programs including,
EMST, TNCC and TNP. Some rural centres ran specific programs (FLECC and TEARS).
Ashton White & Associates May 2013 Page 12
Some major centres ran their own formal nursing courses. The three day trauma
nursing course at RPA and the biannual ultrasound course at Liverpool were cited at
a number of focus groups as of high value.
ITIM education:
All focus groups identified the trauma evenings as of value irrespective of whether
they conducted their own locally or not.
ATTT was considered to be essential but most centres were confident they could
conduct the ATTT program themselves. There was support for the SCSSC providing
expert resource and to provide a train the trainer program. Some focus groups felt
that ITIM did not provide enough sponsored places in ATTT programs and that there
should be more support for developing the expertise locally within a state
curriculum framework.
The TART program was identified as of value but the general view in focus groups
was that there needed to be greater local faculty input – either through increased
resource to build local capacity or through support to enable more local trauma
clinician input to planning and delivery of the program.
AIS training was considered to be valuable. A number of focus groups suggested that
the program would benefit from review so as to include some pre-participation
content that could be undertaken on-line and a reduction in the face to face
requirements. The face to face discussions re coding issues were considered to be
important.
Education priorities for ITIM:
The key priorities identified through the focus groups were:
Support the development and building of capacity locally to deliver the ATTT
program
Develop a trauma nursing course for the state based on the RPA model (reduce
duplication of current programs)
Have a more strategic role in prescribing education standards for trauma services
Recommence the 2 day trauma course run by the coordinators in rotating
locations – content should be based on data and highest education priority (ITIM
should fund and support program)
Use Sydney SCSSC to provide a train the trainer program
Develop or endorse state based algorithms for trauma care
Conduct an annual clinical conference
Ashton White & Associates May 2013 Page 13
Areas for ITIM to assist trauma system with:
Education program for coordinators and data base managers to generate a core
user group for COLLECTOR
Coordinate an annual clinical conference
Develop the web site as the “go to” place for information – includes education
resources, recommended / endorsed programs, links to conferences, guidelines
etc
Promote and market local trauma education across the system
Provide financial support to enable more participation in education activities by
clinicians
Specific areas:
Guidelines:there were mixed views within and between focus groups on the role
that ITIM should have in guideline development and promulgation. Some
participants used the ITIM guidelines as the basis for education and practice whilst
others had not read them.
It was suggested that ITIM should take more responsibility for providing educational
material to promote and support the consistent implementation of guidelines across
the state.
Most major centres have developed their own guidelines and most were happy to
share these with other centres, although there were mixed views about ITIM hosting
all the facility guidelines (as per the ICCMU model). Some participants offered to
work collaboratively with ITIM to develop state guidelines from the current centre
based guidelines.
All the focus groups identified algorithms and flow charts as the most useful practical
resource and a number of centres had 30 or more of these. There was some
evidence of sharing between centres but mostly these were developed locally.
There was general consensus that ITIM could endorse already developed overseas
guidelines but concern by some that they would still need local customisation. There
was little support for ITIM developing the evidence base for guidelines given that it
was available elsewhere.
Some focus groups considered that the role of ITIM should be more focussed on the
provision of guidelines and standards for education that was required of trauma
centres rather than putting resources into clinical guideline development.
Simulation:
Ashton White & Associates May 2013 Page 14
The general view in the focus groups was that there was not equitable access to the
SCSSC via ITIM support and that in most cases local simulation centres were capable
of undertaking equivalent work.
There was recognition of the expertise developed at the SCSSC and the role that it
could play in conducting a state wide train the trainer program as well as being a
source of expert resource (human and equipment).
A number of centres believed that ITIM should be providing resource to enable them
to build capacity and faculty locally and support the wider involvement of simulation
within trauma education.
On-line education:
There was general concern that ITIM appeared to have invested resources in on-line
learning development but that there was no tangible outcome. There was some
support for the STEP concept but recognition that a different approach was needed.
The focus groups identified a number of criteria that should apply to on-line learning
development including building on what already existed, making it simple and
accessible and recognising different skill levels and education needs relevant to the
level of trauma centre.
Focus groups identified a number of existing on-line resources that they considered
could be appropriate for ITIM to endorse or could be used within on-line trauma
education programs.
The role of ITIM should be to endorse/ recommend / make available the content. If
development was required it was suggested that this should be project based and
that ITIM should seconde an appropriate person from within the trauma services to
lead the project.
All focus groups identified that whilst on-line learning is important it is only one part
of mixed modality education and needs to be linked with other modalities.
4. Interviews:
The individual interviews, including ITIM Executive members and ITIM staff, were
structured to understand the key directions that those involved in the ITIM
governance arrangements were considering for future education services. The
results have been summarised as four main themes:
1. Strategic relationships:there was a recurrent theme that ITIM did not have a
strong profile in terms of research and education and that there needed to be a
clear strategy for engagement with the University sector and the wider trauma
community.
Ashton White & Associates May 2013 Page 15
ITIM should be influencing medical and nursing curricula to ensure that trauma
was incorporated earlier in training, developing a strategic partnership with the
Health Education and Training Institute (HETI) for the delivery on on-line learning
and building stronger relationships with professional organisations providing
trauma education.
2. Supporting rural and regional areas:this included support for development of
local capability through enhancing faculty and equipment resources. It was
recognised that building capacity in rural centres is primarily about enhancing
the local capability in a sustainable way and leveraging off the local knowledge
and contextual understanding. This would then facilitate local ATTT and outreach
education within the rural area.
ITIM should host educational resource content centrally so that it was available
and accessible to rural areas. Most metropolitan centres have extensive,
guidelines, algorithms and other resources that could be shared. These need to
be easily accessible at the point of care.
Other suggestions included funding backfill to enable local clinicians to provide
more education, investing in portable simulation resources that can be set up in
various locations and enable more rural sites to have access to this type of
education resource.
3. Innovative education:This should include new approaches to education including
podcasts, Masterclass webinars, and an interactive education site that could be
set up through an ITIM portal or web page.
Using a combination of simulation and ipad technology to generate virtual reality
scenarios and recognising that all simulation does not need to be high tech but
context relevant.
4. Utilising what is already available:There are already credible evidence based
guidelines available and accessible. ITIM should focus on endorsing and /or
making these easily available to the trauma system rather than developing them.
Similarly there are both distance education and on-line education programs
already available and ITIM should be recommending these and providing easy
access to them. One suggestion was to use the Australian HEMS on-line trauma
education resources that are already being used by some medical staff within the
NSW trauma system. Other suggestions included various overseas education
programs. The overarching message was that ITIM should be setting the
expectations for education and being the “go to” place for locating and
understanding what the best resources are.
Ashton White & Associates May 2013 Page 16
4. Discussion
There was strong agreement across the consultation that the role that ITIM should
have in respect of education should be far more strategic. This role extends across
relationships with professional colleges, universities, other non-NSW Health trauma
service providers, the Ministry and the Local Health Districts themselves.
ITIM is well placed to fulfil a more strategic role and the new structure will provide
the vehicle to best leverage the expertise of the wider trauma system in this process.
There is considerable expertise across the trauma system and ITIM needs to develop
strategies for harnessing this to strengthen the “whole of system” approach to
education.
At a system level developing partnerships with HETI, Colleges and the University
sector will enable ITIM to focus more on the prescribing of standards and
expectations for education rather than the “doing”. At all levels of the consultation
there was an expectation that ITIM should be recommending and/or endorsing
education programs and/or resources and that this approach would help in
developing system-wide consistency.
There was a willingness from trauma clinicians and educators to contribute to a
state-wide approach to education and in particular the development of guidelines
and on-line learning. It was clear from the consultation that there is much
duplication across the system, in the absence of clear state direction, in respect of
development of guidelines and on-line learning.
There is an interest and preparedness to work through ITIM to produce consistent
guidelines but the process needs to be different to that previously used and the
focus more on producing practical guidelines that can be adapted for use within
different levels of trauma. Whilst there were mixed views about which were the best
evidence resources there was agreement that ITIM should not be investing in
replicating evidence studies when the evidence was already available but rather
using the education sub-committee to endorse the best evidence and then focus on
the associated guideline development.
The use of the ITIM guidelines was very varied with some centres referring only to
their own guidelines. Most major centres have developed algorithms locally and the
suggestion that ITIM consider investing in a process to agree and share these across
the system had merit as it both promotes consistency and also obviates the need for
multiple concurrent local development activities. The sharing of locally developed
resource centrally has been used successfully by other networks and also warrants
consideration.
Ashton White & Associates May 2013 Page 17
The optimal approach to a development process would be the time limited
secondment of an appropriately skilled trauma clinician / educator to lead a specific
education project (eg development of a guideline). The process would then involve a
wider but specific working group from across the system. This process has been used
successfully for educational resource development in other areas and with good
governance would deliver outcomes within the agreed timelines. The secondary
benefit for ITIM is that there is no need to have a specific education resource
centrally but rather select the appropriate resource depending on the education
project requirements.
In relation to the on-line learning there was evidence of varying levels of local
development of materials across the trauma system but no evidence of a shared
system-wide vision or indeed awareness of what others were developing. There was
support for ITIM to have a lead role in the process and a preparedness to work
together to establish common core learning resources, however there was also
strong support for utilising resources that already existed and making these
available, with appropriate endorsement from ITIM, to the wider trauma system.
There are already a range of education resources – some reflect true on-line
education whilst others are more like distance learning materials. In any event there
is a need to establish a process to review and recommend the best of these rather
than develop new materials. There may be some merit in providing core resources
to support ITIM programs, where these do not already exist, and making these
available across the system to support consistency in education.
A good example of the need for consistent resource material to support education is
for the ATTT program. The strong view from the consultation was that this should be
conducted locally with access to expert resource from SCSSC if required but that
there should be available educational resource material to support a consistent
approach across the state. The resources could be adapted at a local level but the
majority of the content would be consistent. Some centres are better resourced than
others to provide the ATTT locally and this is another area where ITIM could provide
guidance or expectations for what would be required.
It was clear that the SCSSC has been a valuable resource for the state and that the
support through ITIM has been pivotal in ensuring that ATTT can be accessed by all
trauma staff irrespective of LHD. Notwithstanding this contribution, for the future
there needs to be a new model that recognises the local simulation capacity and
educational capability and a refocus of ITIM resource to enhance this. The strong
support for the SCSSC continuing as an expert training resource for the state needs
to be incorporated into the future plan.
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Whilst there was some concern that ITIM did not have an education strategy or plan
and that resource investment was somewhat lacking in direction there was
acknowledgement that ITIM had supported a range of activities consistently over the
years .The challenge now for ITIM is to take advantage of current technology and
communication developments and embed these into the future education strategy.
The role that ITIM has undertaken in respect of the Abbreviated Injury Scale (AIS)
training, organising trauma evenings, coordinating the arrangements for various
programs and supporting local activities are all areas that should continue within an
education plan. They provide a profile for ITIM, substitute for marketing activities
that do not occur currently, are well supported and provide a recognisable education
contribution. What should perhaps be more evident is some strategic thinking and
planning about content that would ensure that both priority issues for the state and
local areas of identified need are addressed within the activities.
The need for a high quality web site (or portal) to support access by the trauma
system to educational resource is another area for consideration. The current web
site could be greatly enhanced to make it more user friendly and easier to navigate.
In any rebuild there should be incorporation of an education portal through which
trauma staff can access links to ITIM recommended educational resources
worldwide, have access to, or participate in, on-line education, find information
about ‘up coming’ education activities and download educational support materials
to assist in delivery of state programs (eg ATTT). Engagement through this type of
web site will encourage a stronger networking culture across the trauma system.
One goal for the review was to identify gaps in trauma education and thus identify
opportunities for ITIM to consider investing resource in, in the future. The greatest
areas of need appeared to be outside the main metropolitan centres (which in most
cases have well established education programs). Support for the major centres to
undertake education activities with their referring centres or for staff from referring
centres to be supported to undertake education activities at major centres are both
models that could be considered. Currently outreach education is very variable
depending on local commitment. Some statement of expected standards of
education from ITIM to major and regional centres would assist in ensuring a more
consistent approach.
Rural centres have particular challenges due to the difficulty in recruiting and
retaining staff and this is often further compounded by less than optimal information
technology access to on-line education resource. Capacity to undertake education
and training locally is important and investment in local simulation capability as well
as local faculty for rural areas may well deliver benefits system-wide given the
amount of trauma that occurs outside the major metropolitan area and importance
of initial management. Whilst the review did not involve an audit of resources it was
Ashton White & Associates May 2013 Page 19
apparent that there is great variability in terms of resources (human and equipment)
for provision of education particularly in rural areas.
5. Summary:The review collected useful information about what education was being undertaken
at the various centres and identified a number of key focus areas that warrant
further consideration by ITIM in the development of an education plan. The most
consistent and main messages for trauma education from all aspects of the review
were:
for ITIM to take a more strategic role in providing guidance for state wide
education standards and expectations
to recognise and support the education needs of rural and referring centres
across the state
to work together as a system to enhance consistency in education through
leveraging existing resources and expertise
Key considerations include:
Establishing the education sub-committee to oversight development and
implementation of the education plan
Developing an education plan, including timelines and accountability for
implementation, for the key focus areas identified in the review report
Determining the priorities for investment of the ITIM education resources for
2013/14
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Appendix 1The survey questions were:
1. What is the name of your organisation? (free text field)
2. Indicate your profession (tick box)
a. Medical
b. Nursing
c. Allied Health
d. Paramedical
e. Other (free text field)
3. Indicate your primary specialty (tick box)
a. Trauma
b. Pre-hospital
c. Emergency
d. Critical Care
e. Surgery
f. Medical
g. Rehabilitation
h. Other (free text field)
4. Indicate your years of trauma experience: (tick box)
a. 0-2 yrs
b. 3-5yrs
c. 5-10yrs
d. >10yrs
5. Have you attended any ITIM education events?
Select one or more of the following or leave blank if not applicable: (tick box, multiselect)
a. Trauma Team Training
b. Trauma Evening seminar
c. Trauma Assessment Resuscitation and Transport (TART) program
d. ITIM Trauma Conference (eg. Trauma on the Coast)
e. AIS Injury Scoring and Techniques course
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6. Have you attended any local trauma education delivered by your organisation?
Select one or more of the following or leave blank if not applicable: (tick box, multiselect)
a. Trauma in-service/lectures
b. Trauma grand rounds
c. Trauma related short courses
d. Conferences
e. Other (free text field)
7. Have you attended any trauma courses delivered by professional bodies or universities? (tick
box)
a. Yes
b. No
8. Indicate which trauma specific short courses delivered by professional bodies you have completed. (Only available if answered yes to Q7, tick box, multiselect).
a. Emergency Management of Severe Trauma (EMST)
b. Definitive Surgical Trauma Course (DSTC)
c. Definitive Perioperative Nurses Trauma Care Course (DPNTC)
d. Trauma Nursing Core Course (TNCC)
e. Trauma Nursing Program (TNP)
f. Prehospital Trauma Life Support (PHTLS)
g. International Trauma Life Support (ITLS)
h. Other (please specify)
9. Indicate which long (post graduate level) trauma related courses you have completed.(Only available if answered yes to Q7, tick box, multiselect).Select one or more of the following or leave blank if not applicable.
a. Trauma Course (eg. Masters of Trauma)
b. Critical Care Course (eg. Masters of Critical Care Medicine/Nursing)
c. Emergency Course (eg. Masters of Emergency Medicine/Nursing)
d. Other (please specify)
10. ITIM’s role in trauma education should be to: (tick box, multiselect)
a. Deliver clinically focussed education in collaboration with local clinicians
b. Support education delivered by local clinicians
c. Coordinate education activities across NSW
d. Develop education content, such as for e-learning, in collaboration with expert
clinicians
e. Act as a portal for information regarding trauma
f. Other (free text field)
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11. Rank the following in order of priority for the use of ITIM education resources: (rank from 1-
4)
a. Coordinate the rollout of the Trauma Team Training course into Major and Regional
Trauma Centres
b. Deliver the AIS Injury Scoring and Techniques course.
c. Focus more on regional and rural areas such as with increased delivery of the TART
program.
d. Develop a trauma e-learning course in collaboration with expert clinicians.
12. Should ITIM develop / update trauma clinical practice guidelines for state-wide
implementation? (tick box)
a. Yes
b. No
13. Which trauma guidelines should be the priority for ITIM to be developing / updating? (Only available if answered yes to Q12, tick box, multiselect)
Select one or more of the following choices.
a. Head injuries
b. Pelvic injuries
c. Airway management
d. Shock management
e. Other (please specify)
14. How could ITIM best assist you in meeting your trauma education needs?( free text field)
15. Please provide any further comments / suggestions (free text field)
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Appendix 2The following were involved through either individual interviews or focus groups in the
consultation associated with this report:
First name Last Name Role
Louise Alderson Paramedic Trauma Advisor
Christine Allsopp Trauma System Monitoring Manager, ITIM
Zsolt Balogh Trauma Director
Cino Bendinelli Deputy Director Trauma
Angela Berry CNC ICU
Kay Best Paediatric Trauma CNC
Erica Caldwell Trauma CNC
Peter Clark Director, ITIM
Anthony Cook Area Trauma CNC
Shane Curran ED Director
Scott D’Amours Trauma Director
Melissa Davis CNE Orthopaedics
Joanne Dungey CNC ED
Natalie Enninghorst Trauma Consultant
Julie Evans Trauma CNC
Kim Fletcher CNC ED
Nevenka Francis Area Trauma CNC
Sonia Gagliard Trauma Dept
Alison Galbraith CNE Orthopaedics
Julie Gawthorne CNC ED
Con Glezos Director, Trauma Surgery
Linda Gutierrez Trauma Data Manager
Kathleen Hain NP, ED
Benjamin Hall Rural Trauma CNC
Benjamin Hardy Research Assistant
Anne Hawkins CNC ED/Critical Care
Rose Hills NUM Orthopaedics
Jeremy Hsu Trauma Director
Dushyant Iyer Trauma Dept
Alicia Jackson Trauma CNC
Tommy Jadlouich Medical Admin Registrar
Emma Jarvis Trauma CNC
Tony Joseph Trauma Director
Sherryn Kieltyka CNE, ED
Kate King Trauma CNC
Penny Kooyman CNC Trauma
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Nimmi Kumar Trauma Data Manager
Mary Langcake Trauma Director
Christine Lassen Manager, ITIM
Cherylene Lee Trauma SRMO
Natalie Lott Trauma RN
Chris Maclaine CNE, ED
Donald MacLellan Director SACC Portfolio, ACI
Renae McCarthy Trauma Case Corrdinator
Karon McDonell CNC Trauma
Debra McDougall Area Trauma CNC
Simone Meakes Trauma CNC
Mathew Moore Paramedic Educator
Mary Morgan Retrieval & ED
Marek Nalos Trauma Director
Kristy O’Brien Nurse Manager, ED
Nicki Pereira CNE Neurosurgery
Kylie Pleming Clinical Skills Coordinator
Elwyn Poynter CareFlight
Kerry Quinn Trauma CNC
Graeme Richardson Director Post Grad Training
Oran Rigby Trauma Director
Patricia Saccasan-Whelan Director Critical Care
Katherine Schraffarczyk Nurse Educator
Julie Seggie Trauma CNC
Maryanne Sewell Rural Trauma CNC
Glenn Sisson Education Manager, ITIM
Carolyn Sommer CNE Neuro & Trauma
Mena Stietiata Surgical Superintendent
Julie Thring Trauma Dept
Sharon Tutton RN, ED
Lauren VanGramberg A/Paediatric Trauma CNC
Ben Watt RN
Dieter Weber Trauma Fellow
Cathy Whiteman CNE, ED
Taneal Wiseman Trauma CNC
Stephanie Wilson Area Trauma CNC
Steve Wood ED Consultant
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Appendix 3Acronyms used in report:
ACI Agency for Clinical Innovation
AIS Abbreviated Injury Scale
ATTT Australian Trauma Team Training
ECI Emergency Care Institute
EMST Early Management of Severe Trauma
FLECC First Line Emergency Care Course
FTE Full time equivalent
HEMS Helicopter Emergency Medical Service
HETI Health Education and Training Institute
ICCMU Intensive Care Coordination and Monitoring Unit
ITIM Institute of Trauma and Injury Management
LHD Local Health District
RPA Royal Prince Alfred
SCSSC Sydney Clinical Skills and Simulation Centre
SSWAHS Sydney South West Area Health Service
STEP Structured Trauma Education Program
TART Trauma Assessment Resuscitation and Transport
TEARS Trauma Education Aimed at Rural Staff
TNCC Trauma Nursing Core Course
TNP Trauma Nursing Program