Quality Assurance System

for the Use of Simulation in Clinical Skills Education

What is Quality Assurance (QA)?

Quality Assurance in education is a system of ensuring that quality management and

quality control processes are in place within an organisation which can demonstrate

training and monitoring of standards. These processes also ensure there is a quality

evidence base. QA identifies where organisations are not meeting standards for

simulation based education and training and outline options for promoting improvement.

The development of a national strategy for clinical skills education in Scotland required a

quality assurance system to be in place for simulation based education to set up a

continuous improvement culture of clinical skills practice by individuals or teams of

health care practitioners. A Quality Assurance system ensures that standards of simulation

based education are accessible to all health care practitioners wherever they practice and

whatever their professional background. The following information is framed around

three questions

What QA frameworks have contributed to the development of a QA system for

Simulation Based Education?

What is the Scottish Simulation Based Education QA System?

How was the QA System for Simulation Based Education developed?

What QA frameworks have contributed to the development of a QA system for

Simulation Based Education?

The following sources have informed the development of a QA system for Simulation

Based Education. Each recognises the need to ensure educational standards are being

continuously improved and updated for all health care practitioners.

1. The Nursing and Midwifery Council (NMC)

The NMC updated their QA framework for education in 2016. The principles for the

framework include Transparency, Clarity, Utility, Accountability and Improvement. The

standards for the approved programmes (over 100) it runs informs their role as a

professional regulator rather than an educational regulator which links into the Quality

Assurance Agency (QAA) for higher education. The NMC regulates within a ‘right touch’

regulation system set out by the Professional Standards Authority (PSA). Right touch

regulation is defined as being proportionate, consistent, targeted, transparent,

accountable and agile. In order to provide public protection as a professional regulator it

delivers QA through four areas, as follows:

Approval against standards

Education reviews

Responding to concerns

Reporting and sharing evidence

NMC QA Framework for nursing and midwife education

2. The Health Professions Council (HPC)

The HPC is a regulator which keeps a register of health care practitioners who practice to

an agreed standard. It is a statutory body which approves educational programmes

necessary ‘to achieve standards of proficiency’. It currently approves 94 education

providers providing 424 separate programmes. The following professions are included:

arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists,

dietitians, hearing aid dispensers, occupational therapists, operating department

practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists,

prosthetists/orthotists, radiographers, social workers in England and speech and

language therapists. The HPC is currently responding to the latest Enhancing Quality In

Practice Framework (EQuIP).

HPC Healthcare Education QA Framework

3. The General Medical Council (GMC)

The GMC QA Framework covers both undergraduate and postgraduate education and

links into Promoting Excellence the standards for medical education and training

GMC Promoting Excellence

The QA system clarifies the role of NHS providers, Higher Education Institutions (HEIs)

Postgraduate providers and Royal Colleges in Quality Assurance, Quality Management and

Quality Control.

GMC QA Framework

4. The Higher Education Academy (HEA) UK

The HEA UK Professionals Standards Framework links standards of educational activity to

core knowledge requirements about education and professional values with a focus on

continuous improvement.

HEA UK Professionals Standards Framework

5. The Academy of Medical Educators (AoME)

The AoME set out to become the standard setting body for medical educators in the UK. In 2009, it

achieved this aim with the publication of the Professional Standards that define the level of

competence that medical educators should achieve at each point in their careers. The core

domains they identified include

Designing and planning learning

Teaching and facilitating learning

Assessment of learning

Educational research and scholarship

Educational management and leadership

AoME Professional Standards

6. Skills Development Scotland

SDS has developed an action plan template which is linked to improvement; the headings of which are shown below.

SDS Quality Action Plan Template

Organisation: Period of Action Plan:

StandardsAreas for

Improvement to be Implemented

Individual responsible for

Action

Date ActionStarted / Finished

Resources Required

Review of Actions

The organisation covers a wide variety of opportunities to enhance the workforce.

SDS What We Do

7. The Association for Simulated Practice in Healthcare (ASPiH)

This UK organisation was established in 2012-13.

It has developed a standards Framework using an expert panel which was published in

2015 and focuses on four themes with 21 associated standards:

Resources

Faculty

Activity and

Technical personnel

ASPiH Standards for SBE in Healthcare

How was the Scottish QA System for Simulation Based Education (SBE) developed?

In implementing the Scottish Clinical Skills Strategy in 2008 it was essential to ensure that

health care practitioners from different disciplines and from different geographical areas

had access to the same standards of SBE whether delivered on the mobile skills unit, in

fixed facilities or in situ in the workplace.

In 2009, the Clinical Skills Managed Educational Network began to explore a system for

defining key quality standards for clinical skills education using simulation. A modified

Delphi approach was used to develop consensus.

The development of a Scottish QA system for on line Clinical Skills resources to enhance

SBE was developed in parallel with the delivery of faculty development and in relation to

national skills programme priorities building on the relevant frameworks highlighted in

the previous section.

What is the Scottish SBE QA System?

This SBE QA Framework was developed to reflect the following educational process:

Brief

Faculty

o A three-tiered approach was developed to identify key improvement

outcomes

Tier 1 - practitioner educators of SBE,

Tier 2 - leaders of SBE and

Tier 3 - researchers of SBE (available to download)

This outcome framework has been matched vs AoME, ASPiH and GMC

frameworks

Technical support

o A modified Delphi approach is being used to identify nationally agreed

capabilities for all Simulation technicians (available download in

development)

Facilities

o A national database of facilities and their capabilities in terms of specialist

equipment has been developed

o A mobile skills unit (MSU) with the same access to video debriefing and

standard simulators and part task trainers is operational

o Resources

A generic approach to on line development of clinical skills has been

agreed and utilised in the development of evidence based on line

resources CS MEN online resources

Immersion

Programmes

o A self-assessment questionnaire to be used for Quality Assurance of

educational programmes

o A one-page questionnaire for use with individual skills sessions where

simulation is used

o Provision of QA programmes on MSU e.g. BLS, ALS, PROMPT

Scenarios

o A scenario template for designing a SBE session has been developed to

ensure standards of design are considered in the development of new

scenarios

Specialist equipment

o standard manikins and part task trainers in all SBE facilities

o one way mirror and video debriefing capability in all SBE facilities

Debrief

o System of review and improvement

o On line resources currently updated biannually

o System of visits to remote and rural venues by MSU

o A national course for the MSU has been implemented

o A national faculty database is being developed

The common quality standards, educational resources and training programmes

developed and delivered through the Scottish QA system for SBE are subject to an

independent, robust and open review process. This will give the public and health service

managers confidence in the quality of clinical skills education and delivery and enable the

skills training to be explicitly linked with UK and Scottish competency frameworks.

Clinical skills training impacts directly on the quality of care patients receive. Patients are

the ‘touch point’ of the service. Consequently, the quality assurance process must

encompass not only educational governance but clinical and staff governance issues as

well. In Scotland, Quality Improvement Scotland (QIS) is responsible for promoting

patient safety through ensuring clinical standards of care. NHS QIS is committed to

working collaboratively on the development of the Clinical Skills Managed Educational

Network as we seek to promote best practice and improve the quality of healthcare.

NES has responsibility for providing and promoting education to all NHS staff and has

developed an educational governance framework for ensuring that educational resources

and processes can be measured against explicit quality standards and criteria. The

Scottish QA system for SBE underpins the implementation of the Scottish Clinical Skills

Strategy.