A total of 105 medical personnel volunteers and contractors were recruited from within the Province of British Columbia and from across Canada to provide the required medical expertise to staff and operate the MMU during the 2010 Winter Games. Recruitment advertisements specified qualifications/criteria for selection. Successful applicants were credentialed through VGH, VCH, and VANOC prior to enrollment. Experts recruited for participation included anesthesiologists, general and orthopaedic trauma surgeons, emergency, critical care, and operating room nurses, and respiratory therapists.
Participants were grouped into five 17-person teams. Each team comprised of two trauma/general surgeons, two anesthesiologists, two orthopedic trauma surgeons, four operating room nurses, four critical care nurses, two emergency nurses, and one respiratory therapist. Each team was deployed for a 10 to 14 day rotation to provide care and continued support for the Whistler Olympic Village Polyclinic.
Education and training model
MMU participants completed a four-phase education and training curriculum prior to deployment in effort to foster the performance of a high functioning interdisciplinary team. Instruction was provided in collaboration with VGH, CFTTC(W), the Centre for Excellence for Simulation Education and Innovation (CESEI) at VGH, and the VCH Learning & Development division. Training programs were delivered between October 2009 and March 2010. The training model included the following phases:
Phase 1: weekend training
In October 2009, medical personnel attended a 2.5 day workshop at VGH. The purpose of this training phase was to introduce team members to other participants and provide an opportunity to become accustomed to the MMU facility. During this time all participants were also orientated with the triage and delivery structure for how medical services were to be provided across all Olympic venues. As well they were provided with classroom learning and instruction to increase their content familiarity with the MMU in order to problem solve potential treatment challenges they may face.
Phase 2: web-based modules
Following the weekend training seminar, participants completed a series of “mandatory” and elective web-based learning modules. Learning modules were distributed through CESEI and VCH Learning and Development. Topics included Infection Control Basics (hand hygiene), Central Venous Catheter Care & Maintenance, Safe Blood Transfusion, Workplace Hazardous Materials Information System Basics, VANOC 2010 medical services, Introduction to the Mobile Medical Unit – History and Planning, Summary of Whistler Polyclinic and Mobile Medical Unit, Mobile Medical Unit Orientation to Physical Lay Out and Patient Flow, 2010 Olympic/Paralympic MMU Blood Education Overview, Transfusion Medicine Services, Introduction to METI Emergency Care Simulator (ECS) and Introduction to METI Human Patient Simulator (HPS). Mandatory learning modules included Blood Transfusion and Infection Control Basics (hand hygiene).
Phase 3: “just-in time” training
In the week prior to deployment, participants completed a series of simulation training exercises in a mock up MMU in CESEI over the span of 1.5 days. Training included simulations as well as small and large group sessions. CFTTC(W) provided leadership in each exercise. Simulation exercises escalated in complexity over time, beginning with: (1) an introduction of team dynamics and trauma protocols; (2) orientation session and familiarization with the mock trauma bay, OR, Emergency Care Simulator (ECS) and Human Patient Simulator (HPS); (3) scenario based trauma management sessions followed by debriefings; and (4) mass casualty and complex case-based scenarios followed by debriefings. Simulation exercises were modified based on scenarios learned from previous team experiences consistent with a rapid cycle change problem solving philosophy.
Phase 4: daily simulation training
Simulation and training were imbedded into the daily routines for the MMU and polyclinic team. Daily simulation exercises ranged in complexity, beginning with simple case scenarios and moving toward more complex situations such as Code Blue simulations in all areas of the Whistler Polyclinic (eg, Dentistry, Therapy, MRI), a series of outreach responses in the Whistler Athletes Village, and the complex Long-Line Helicopter Evacuation from the event scene to the MMU. Arrangements were made to run these simulations while still conducting the normal operations of the Polyclinic. All scenarios were executed in “real time” whenever possible with fully integrated communications with other participating agencies (eg, event security, ski patrol etc.). An important aspect of the training was the formative debriefings held after each simulation. The debriefings allowed learnings to be discussed that built further team confidence within the new environment.
Survey of clinical staff satisfaction of the training program
Clinical staff were recruited by e-mail using their contact information obtained from the MMU/PC management office database. Inclusion criteria for our study were as follows: (1) having completed a rotation of at least four days serving with the MMU/PC in Whistler during the Games, and (2) having completed at least one of the four phases of pre-deployment training. All persons who participated in the preparation or delivery of the MMU/PC training programs were excluded from the survey.
Participants received a letter of initial contact from the Principal Investigator outlining the purpose and procedures of the study. Attached to this email they received a link to a secure online survey hosted at FluidSurveys (Chide.it Inc., Ottawa, Ontario).
Training assessment survey
All assessment questions were constructed from focus group discussions with MMU/PC staff. Questions were based on the phases of training that were provided prior to deployment and pilot-tested with MMU/PC staff. The survey was divided into three sections: responses to individual training phases; responses on overall course satisfaction; and demographic and work-related experience profiles. The survey was designed to require approximately 15 minutes to complete and would allow participants to save their progress in the event that the could not complete the entire survey in one sitting.
Most of the questions were closed-ended, but participants were encouraged to provide additional content in the event they wished to provide more specific feedback. Close-ended questions followed a five-point Likert scale ranging from very valuable, somewhat valuable, neutral, minimally valuable, and not at all valuable. The survey also included open-ended questions in which participants were asked to respond in their own words regarding the quality and amount of simulation training that was provided, whether they have since implemented or incorporated any of the learning approaches into practice at their home hospital/agency, and whether they had any other comments or suggestions regarding the education and training that they received during the MMU/PC training period. The survey was posted on-line between May 20, 2011 and August 8, 2011. The study was approved by the Behavioral Research Ethics Board at the University of British Columbia.
Descriptive statistics and cross-tabulations were calculated for each survey item. Responses were stratified by clinical job title, years of experience, and prior experience working in large scale events. Differences between means of continuous variables were examined using a two-tailed t-test, and differences in proportions of categorical variables were examined using a chi square test. We examined all categorical variables where expected values were less than five using Fisher’s exact test. A significance level of 0.05 was used to assess all bivariate relationships. All statistical analyses were generated using SAS software, Version 9.2 for Windows .