Paediatric mass casualty response through the lens of Functional Resonance Analytical Methodology- lessons learned.

BACKGROUND: Mass Casualty Incidents are rare but can significantly stress healthcare systems. Functional Resonance Analytical Methodology (FRAM) is a systematic approach to model and explore how complex systems adapt to variations and to understand resilient properties in the face of perturbations. The aim of this study was to use FRAM to create a model of a paediatric trauma system during the initial response to the Manchester Arena Attack to provide resilience-based insights for the management of future Mass Casualty Incidents (MCI). METHODS: Qualitative interviews in the immediate aftermath of a terrorist bombing, were followed up with further in-depth probing of subject matter experts to create a validated and verified FRAM model. This model was compared with real incident data, then simplified for future studies. RESULTS: A Work As Imagined (WAI) model of how a paediatric emergency department provided resilient healthcare for MCI patients from reception and resuscitation to definitive care is presented. A focused model exploring the pathway for the most severely injured patients that will facilitate the simulation of a myriad of potential emergency preparedness resilience response scenarios is also presented. CONCLUSIONS: The systematic approach undertaken in this study has produced a model of a paediatric trauma system during the initial response to the Manchester Arena Attack, providing key insights on how a resilient performance was sustained. This modelling may provide an important step forward in the preparedness and planning for future MCIs.

Frontline learning of medical teaching: "you pick up as you go through work and practice".

BACKGROUND: Few medical teachers have received formal teaching education. Along with individual and organizational barriers to participation in teacher training programs, increasing numbers and altered distribution of physicians away from major teaching centers have increased the difficulty of attendance. Furthermore, it is not known if traditional faculty development formats are the optimal learning options given findings from existing studies document both positive and negative outcomes. There is a gap in research that explores how medical teachers learn to teach and also limited research regarding how medical teachers actually teach. The purpose of this study was to provide insight into how physicians describe their teaching of trainees, and the nature of their teaching development and improvement to inform faculty development programs. METHODS: Semi-structured interviews were conducted with 36 physicians, with a broad range of teaching experience, purposefully selected from five disciplines: Internal Medicine, Pediatrics, Psychiatry, Surgery, and Family Medicine. A qualitative, inductive approach was used to analyse the data. RESULTS: Teaching was described as being centered on the needs of individual trainees, but was dependent on patient presentation and environmental context. For this group of physicians learning to teach was perceived as a dynamic and evolving process influenced by multiple life experiences. The physicians had not learnt to teach through formal education and then put that learning into practice, but had learnt to teach and improve their teaching through their trial and errors teaching. Life experiences unconnected with the medical environment contributed to their knowledge of teaching along with limited formal learning to teach experiences. Teaching practice was influenced by peers and trainees, feedback, and observation. The findings suggest these medical teachers learn to teach along a continuum largely through their teaching practice. CONCLUSION: The findings suggested that the participants' major resource for learning how to teach was informal experiential learning, both in and out of the workplace. This may have implications for faculty development strategies for medical teaching education.