Challenges of location
Mental health care training for practitioners in remote and rural areas Greg de Mello, Fiona Fraser and Pam Nicoll, NHS Education for Scotland, Remote and Rural Healthcare Educational Alliance, Inverness, UK Jean Ker, Clinical Skills Centre, University of Dundee, UK Gill Green, Self-Harm Mitigation Training (STORM) Project, University of Manchester, UK Colville Laird, British Association for Immediate Care, Scotland (BASICS), Aberuthven, UK
Rural and island health care staff are required to manage patients experiencing mental health crises
SUMMARY Background: Rural and island health care staff in Scotland are required to manage patients experiencing mental health crises. To ensure practitioners in remote and rural areas have the necessary skills, the Remote and Rural Healthcare Educational Alliance (RRHEAL) were asked to develop a pre-hospital mental health care course. Methods: Several mental health care experts were asked to express an opinion on the essential content of such a course. Stakeholder review informed the development of a survey to identify the priority areas for training. The first round of the survey process involved an expert
group of 16; the second round used a survey of over 300 remote and rural practitioners involved with the British Association for Immediate Care, Scotland (BASICS). Results: The stakeholder review identified key content, summarised under the following topics: risk assessment; patient assessment; crisis management; handling difficult situations; engagement skills; mental health law; management of retrieval; pharmacology; theory and classification of mental illness; and understanding your network. Discussion: This article shares how the needs within a national pre-hospital mental health care programme were identified, and
384 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
demonstrates how consensus over the content of a national course was achieved through the use of a modified Delphi approach. The Clinical Skills Managed Educational Network (CSMEN), Self-Harm Mitigation Training (STORM) and BASICS, alongside RRHEAL, contributed to this development. Using blended learning techniques the resulting course encourages a contextual approach to user needs, specifically teaching generic mental health care skills to staff who are often working single-handed, and are required to respond appropriately, locally and safely as they work towards achieving National Mental Health crisis standards.
INTRODUCTION
Management of mental health crises in remote and rural areas presents unique challenges
T
he delivery of mental health services are particularly challenging, often requiring crisis intervention teams as well as community support teams. The clients or patients with mental health illness also have unique issues that may also be demanding in terms of delivering a wellcoordinated and supportive service when required. Many countries worldwide have a significant part of their population living in remote and rural areas, yet most governments recognise the need for equitable access to high-quality health care services for all patients, regardless of their geographic location or health need.
The management of mental health crises in remote and rural areas presents unique challenges for health care practitioners.1 These include: the development and maintenance of expertise in the initial response to a patient with a mental health crisis when there are no locally available specialist services; the demands of being the only available health care practitioner with responsibility for all aspects of health care, not only for clients and patients with mental health issues; and the time delays encountered in relation to transport to specialist services. An additional challenge often encountered in remote, rural and island areas is a delay in clients seeking help for mental health issues. This can be because of the perception that there is a lack of confidential help as a result of clients, carers and health care staff living alongside one another in a tight-knit community. In remote and rural settings much of the first emergency response is likely to be dependent on primary care services, and particularly general practitioners. There are reports from those who work in remote and rural areas of feeling inadequately prepared to manage
mental health crises, and having difficulty in sourcing training to supplement their education.1
simulation-based educators and state of the art video debriefing facilities.5
This article shares how a national pre-hospital mental health care programme was identified.
The Scottish Government established Health Efficiency Access and Treatment (HEAT) targets as a core set of ministerial objectives, targets and measures for the NHS in Scotland that build on the Choose Life National Strategy and Action Plan launched in 2002, which set out to reduce the suicide rate between 2002 and 2013 by 20 per cent.6
BACKGROUND National Health Service Education for Scotland (NES) is the national body charged with developing and delivering training to people who work in the National Health Service (NHS) in Scotland. A government review identified a need to ensure that training was appropriate for health care staff working in rural services.2 The Remote and Rural Healthcare Educational Alliance (RRHEAL) was established to coordinate remote and rural education, and to ensure that education programmes that are delivered are appropriate for rural services.2,3 In addition, to support health care practitioner’s skills development and maintenance, in 2007 the Scottish Government launched a clinical skills strategy, the first national skills strategy in the world.4 This prioritised education and training for remote and rural practitioners by bringing standard opportunities of skills education to their place of work, using a mobile skills facility with
To achieve this, it required that 50 per cent of key front-line staff in mental health and substance misuse services, primary care, and accident and emergency needed to be educated in using suicide assessment tools and suicide prevention training.7 RRHEAL led the coordination on development of a pre-hospital mental health emergency care course aligned to the local psychiatric emergency plan. The challenge was to ensure the course was to a national standard but had local applicability.
METHODS A structured review of training and education resources associated with mental health crises was undertaken. A modified ‘Delphi’ approach was adopted in order to seek consensus from an expert group regarding training
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388 385
Initial firststage telephone interviews yielded key priorities
needs.8 This enabled agreement to be reached without undue emphasis on agendas from any one interest group and, given the wide geographical location of expertise, was the most cost effective approach. The Delphi model is a multistage survey approach to gaining consensus on a key issue. It was originally defined as a method that obtains the ‘most reliable consensus of opinion across a group of experts’, using a series of intensive questionnaires and controlled or filtered feedback.9 It is of particular relevance when input from a dispersed or crossorganisational panel is required. Although the Delphi technique evolved in modern times from forecasting in the military context,8 there are now increasing applications within health care as a tool for the identification of, and achieving consensus on, key priorities, including educational need. For the purposes of the prehospital programme, initial firststage telephone interviews yielded key priorities. Following an analysis of key statements these were then distributed in the second round in an e-survey. Respondents then ranked these, yielding concordance for the development of the programme. A Delphi approach does not yield a correct solution, but an agreed or consensus solution, thus contextually relevant factors can be taken into account by a diverse expert panel.10 Stage 1 RRHEAL consulted with NHS Boards and identified 15 individuals with experience and recognised local expertise in managing remote and rural mental health crises. These informants agreed to shape an expert panel. They were interviewed by a project officer, either by phone or face to face, using a semi-structured interview. Each of the informants was asked
open questions to identify key issues in the management of mental health crises. Stage 2 In order to identify how widely these topics were endorsed by the entire expert panel, a survey was carried out to rate each of the areas in terms of importance. This secondary questionnaire was conducted by an electronic questionnaire–response mechanism. Stage 3 The survey was repeated using a database held by the British Association of Immediate Care, Scotland (BASICS) of remote and rural practitioners in Scotland who provide pre-hospital immediate care. Stage 4 Following the Delphi, a fourth stage was undertaken to match the results of the stage-3 ratings against existing educational materials related to mental health crisis training. This included the Royal College of Psychiatrists, NHS Health Scotland, Self-Harm Mitigation Training (STORM) and NHS Education for Scotland Mental Health and general practice education teams.
Analysis of the data was supported with the application of radar charts. A radar chart (or star ⁄ spider chart) has an axis for each topic area covered in the survey. The axis extends outwards from a central point, with the value of each data point plotted on the corresponding axis. Radar charts are used in multiples to compare findings and are therefore useful ways of representing multivariate observations, this approach often being taken to establish benchmarks. By establishing patterns (on different radar charts), it can be easier to locate exceptions to the pattern, and as a result, dissimilar findings.11
RESULTS Significant accessible resources of relevance to this training were located within the Royal College of Psychiatry, in the form of e-learning modules. In addition, existing curricular objectives and training materials that were complementary to the context of rural provision, and to the aspirations of this new educational programme, were found
Table 1. Profession of respondents Profession
Expert panel survey n = 13
Mental health nurse
4
Consultant psychiatrist
4
Mental health projects manager
1
Highland user group
1
General practitioner
3
BASICS survey n = 80 1
63
Consultant A&E
1
Resuscitation officer
1
General nurse
3
Paramedic
7
Medical student
2
Nurse practitioner
1
Student nurse
1
386 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
Rating Average - Expert Rating Average - BASICS 1 2.50
21 20
2 3
2.00
19
4
1.50 1.00
18
5
0.50 17
6 0.00
16
7
15
8
14
9 13
10 12
11
Figure 1. Assessment of risk: 1, environmental risks; 2, personal risks; 3, risks to the individual; 4, mental health history; 5, history of the current event; 6, current and future risks; 7, involving the carers and network; 8, keeping yourself safe; 9, support networks; 10, lone working policy; 11, developing supportive networks; 12, significant event analysis; 13, positive risk taking; 14, triage; 15, risk management; 16, ‘at-risk’ register; 17, aggression management theory and practice; 18, deliberate self harm theory and interventions; 19, suicide risk assessment; 20, understanding the risk to others; 21, communication of risk Rating Average - Expert
20
2
4
1.50 1.00
18
5
0.50 6
17 0.00
7
16
8
15
14
9 13
10 12
11
Figure 2. Patient assessment
to have been developed previously by STORM.12
• crisis management;
Seventeen experts from across Scotland agreed to form the expert panel and were interviewed. The following topics were identified:
• engagement skills;
• risk assessment; • patient assessment;
The results of the expert’s survey and the BASICS survey are presented as radar charts in Figures 1–3. Figure 1 is an example of the level of agreement between the expert and BASICS group within each topic area demonstrated in the results. It shows how respondents assessed each of the identified themes and demonstrates that, with the exception of developing an ‘at-risk’ register, both groups agreed on the contents of the topic areas. Figures 2 and 3 demonstrate that in each of the topic areas included in the online survey there was a high level of agreement between the different respondent groups for the contents of the course.
3
2.00
19
Table 1 shows the professional background of respondents to the surveys. Eighty-two per cent of the expert panel responded to the stage-2 online survey, and 23 per cent of the BASICS practitioners surveyed completed the questionnaire.
[There is a] need for more context-specific training opportunities for remote and rural practitioners
Rating Average - BASICS
1 2.50
21
• understanding your care network.
• handling difficult situations;
• mental health law; • management of retrieval; • pharmacology; • theory and classification of mental illness;
CONCLUSION This article demonstrates how consensus over the content of a national course can be achieved through the use of a modified Delphi approach, which, given the different interested groups and diverse agendas, represents a great achievement. There was strong agreement between the expert group and the practitioners in terms of prioritising the content areas. It also highlights the need for more context-specific or inclusive training opportunities for remote and rural practitioners. Stage 4 of the process identified a number of online resources that could be used to
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388 387
It demonstrates how important it is to design educational programmes that align with government policy
Rating Average - Expert Rating Average - BASICS
1 2.50 13
2
5. NHS Education for Scotland. Evaluation of the Mobile Clinical Skills Unit. 2010. Available at http:// www.csmen.scot.nhs.uk/media/ 1808/evaluationofthepilotofthemo bileclinicalskillsunit2011.pdf. Accessed on 3 April 2013.
2.00 1.50
12
3
1.00 0.50
11
4
0.00
10
5
9
6 8
7
Figure 3. Engagement skills
efficiently deliver some of the knowledge content of the course at a distance. It also demonstrates how important it is to design educational programmes that align with government policy or strategy, provide a national standard and that are inclusive of the needs of health care practitioners in remote locations. One of the remaining challenges is ensuring the continuing development of trainers or faculty staff to deliver the course, as well as leadership in developing and maintaining the course. REFERENCES 1. Dunn P, Cantrell J, Swan G. Mapping Current Educational Provision for Healthcare Professionals in Remote and Rural Areas. NHS Education: 2007. Available at http://www.nospg.nhsscotland.com/wp-content/
skills_strategy_exec_summary.pdf. Accessed on 21 February 2012
25-10_i_Training-Needs-in-MentalHealth-crisis-response-in-rural-Scotland_RRHEAL_2010.pdf. Accessed on 9 April 2012 2. Scottish Executive Health Department. Delivering for Remote and Rural Healthcare: The final report of the Remote and Rural work stream. Edinburgh: Scottish Executive Health Department; 2008. Available at http://www.scotland.gov.uk/ Publications/2008/05/06084423/0. Accessed on 21 February 2012 3. NHS Scotland Final Report of the Remote and Rural Implementation Group. Remote and Rural Implementation Group (RRIG), 2010. Available at http://www.nospg.nhsscotland.com/wp_content/3.Final_ Report_RRIG_Oct10.pdf. Accessed on 21 February 2012. 4. NHS Education for Scotland. Partnerships for Care: Taking Forward the Scottish Clinical Skills Strategy. Executive Summary: 2007. Available at http://www.csmen.scot.nhs.uk/ media/1867/scottish_clinical_
6. Scottish Executive Health Department. Choose Life Strategy and Action Plan. Edinburgh: Scottish Executive Health Department; 2002. Available at http://www.scotland.gov.uk/Resource/Doc/46932/ 0013932.pdf. Accessed on 21 February 2012 7. Scottish Executive Health Department. Delivering for Mental Health: The Mental Health Delivery Plan for Scotland. Edinburgh: Scottish Executive Health Department; 2006. Available at http://www.scotland.gov.uk/Resource/Doc/157157/ 0042281.pdf. Accessed on 21 February 2012. 8. Keeney S, Hasson F, McKenna H. The Delphi Technique in Nursing and Health Research. Oxford: Wiley– Blackwell; 2011. 9. Dalkey N, Helmer O. Delphi technique: characteristics and sequence model to the use of experts. Management Science 1963;9:458–467. 10. Watson R, McKenna H, Cowman S, Keady J. Nursing Research Designs and Methods. Edinburgh: Churchill Livingstone; 2008. 11. Pope C, Mays N, Popay J. Synthesizing Qualitative and Quantitative Health Evidence: A guide to methods. Maidenhead: Open University Press: 2007. 12. STORM. Skills-based Training on Risk Management. Available at http:// www.stormskillstraining.co.uk/ about_storm. Accessed on 18 April 2012.
Corresponding author’s contact details: Fiona Fraser, Remote and Rural Healthcare Educational Alliance (RRHEAL), Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Approval for this work was governed by professional codes of practice, as the article illustrates a clinical practice development ⁄ education. The development of the enquiry that led to the development of the course was also put before the ethics committee at Dundee University, with leadership from Dr Jean Ker, who is based there. doi: 10.1111/tct.12054
388 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
Mental health care training for practitioners in remote and rural areas Greg de Mello, Fiona Fraser and Pam Nicoll, NHS Education for Scotland, Remote and Rural Healthcare Educational Alliance, Inverness, UK Jean Ker, Clinical Skills Centre, University of Dundee, UK Gill Green, Self-Harm Mitigation Training (STORM) Project, University of Manchester, UK Colville Laird, British Association for Immediate Care, Scotland (BASICS), Aberuthven, UK
Rural and island health care staff are required to manage patients experiencing mental health crises
SUMMARY Background: Rural and island health care staff in Scotland are required to manage patients experiencing mental health crises. To ensure practitioners in remote and rural areas have the necessary skills, the Remote and Rural Healthcare Educational Alliance (RRHEAL) were asked to develop a pre-hospital mental health care course. Methods: Several mental health care experts were asked to express an opinion on the essential content of such a course. Stakeholder review informed the development of a survey to identify the priority areas for training. The first round of the survey process involved an expert
group of 16; the second round used a survey of over 300 remote and rural practitioners involved with the British Association for Immediate Care, Scotland (BASICS). Results: The stakeholder review identified key content, summarised under the following topics: risk assessment; patient assessment; crisis management; handling difficult situations; engagement skills; mental health law; management of retrieval; pharmacology; theory and classification of mental illness; and understanding your network. Discussion: This article shares how the needs within a national pre-hospital mental health care programme were identified, and
384 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
demonstrates how consensus over the content of a national course was achieved through the use of a modified Delphi approach. The Clinical Skills Managed Educational Network (CSMEN), Self-Harm Mitigation Training (STORM) and BASICS, alongside RRHEAL, contributed to this development. Using blended learning techniques the resulting course encourages a contextual approach to user needs, specifically teaching generic mental health care skills to staff who are often working single-handed, and are required to respond appropriately, locally and safely as they work towards achieving National Mental Health crisis standards.
INTRODUCTION
Management of mental health crises in remote and rural areas presents unique challenges
T
he delivery of mental health services are particularly challenging, often requiring crisis intervention teams as well as community support teams. The clients or patients with mental health illness also have unique issues that may also be demanding in terms of delivering a wellcoordinated and supportive service when required. Many countries worldwide have a significant part of their population living in remote and rural areas, yet most governments recognise the need for equitable access to high-quality health care services for all patients, regardless of their geographic location or health need.
The management of mental health crises in remote and rural areas presents unique challenges for health care practitioners.1 These include: the development and maintenance of expertise in the initial response to a patient with a mental health crisis when there are no locally available specialist services; the demands of being the only available health care practitioner with responsibility for all aspects of health care, not only for clients and patients with mental health issues; and the time delays encountered in relation to transport to specialist services. An additional challenge often encountered in remote, rural and island areas is a delay in clients seeking help for mental health issues. This can be because of the perception that there is a lack of confidential help as a result of clients, carers and health care staff living alongside one another in a tight-knit community. In remote and rural settings much of the first emergency response is likely to be dependent on primary care services, and particularly general practitioners. There are reports from those who work in remote and rural areas of feeling inadequately prepared to manage
mental health crises, and having difficulty in sourcing training to supplement their education.1
simulation-based educators and state of the art video debriefing facilities.5
This article shares how a national pre-hospital mental health care programme was identified.
The Scottish Government established Health Efficiency Access and Treatment (HEAT) targets as a core set of ministerial objectives, targets and measures for the NHS in Scotland that build on the Choose Life National Strategy and Action Plan launched in 2002, which set out to reduce the suicide rate between 2002 and 2013 by 20 per cent.6
BACKGROUND National Health Service Education for Scotland (NES) is the national body charged with developing and delivering training to people who work in the National Health Service (NHS) in Scotland. A government review identified a need to ensure that training was appropriate for health care staff working in rural services.2 The Remote and Rural Healthcare Educational Alliance (RRHEAL) was established to coordinate remote and rural education, and to ensure that education programmes that are delivered are appropriate for rural services.2,3 In addition, to support health care practitioner’s skills development and maintenance, in 2007 the Scottish Government launched a clinical skills strategy, the first national skills strategy in the world.4 This prioritised education and training for remote and rural practitioners by bringing standard opportunities of skills education to their place of work, using a mobile skills facility with
To achieve this, it required that 50 per cent of key front-line staff in mental health and substance misuse services, primary care, and accident and emergency needed to be educated in using suicide assessment tools and suicide prevention training.7 RRHEAL led the coordination on development of a pre-hospital mental health emergency care course aligned to the local psychiatric emergency plan. The challenge was to ensure the course was to a national standard but had local applicability.
METHODS A structured review of training and education resources associated with mental health crises was undertaken. A modified ‘Delphi’ approach was adopted in order to seek consensus from an expert group regarding training
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388 385
Initial firststage telephone interviews yielded key priorities
needs.8 This enabled agreement to be reached without undue emphasis on agendas from any one interest group and, given the wide geographical location of expertise, was the most cost effective approach. The Delphi model is a multistage survey approach to gaining consensus on a key issue. It was originally defined as a method that obtains the ‘most reliable consensus of opinion across a group of experts’, using a series of intensive questionnaires and controlled or filtered feedback.9 It is of particular relevance when input from a dispersed or crossorganisational panel is required. Although the Delphi technique evolved in modern times from forecasting in the military context,8 there are now increasing applications within health care as a tool for the identification of, and achieving consensus on, key priorities, including educational need. For the purposes of the prehospital programme, initial firststage telephone interviews yielded key priorities. Following an analysis of key statements these were then distributed in the second round in an e-survey. Respondents then ranked these, yielding concordance for the development of the programme. A Delphi approach does not yield a correct solution, but an agreed or consensus solution, thus contextually relevant factors can be taken into account by a diverse expert panel.10 Stage 1 RRHEAL consulted with NHS Boards and identified 15 individuals with experience and recognised local expertise in managing remote and rural mental health crises. These informants agreed to shape an expert panel. They were interviewed by a project officer, either by phone or face to face, using a semi-structured interview. Each of the informants was asked
open questions to identify key issues in the management of mental health crises. Stage 2 In order to identify how widely these topics were endorsed by the entire expert panel, a survey was carried out to rate each of the areas in terms of importance. This secondary questionnaire was conducted by an electronic questionnaire–response mechanism. Stage 3 The survey was repeated using a database held by the British Association of Immediate Care, Scotland (BASICS) of remote and rural practitioners in Scotland who provide pre-hospital immediate care. Stage 4 Following the Delphi, a fourth stage was undertaken to match the results of the stage-3 ratings against existing educational materials related to mental health crisis training. This included the Royal College of Psychiatrists, NHS Health Scotland, Self-Harm Mitigation Training (STORM) and NHS Education for Scotland Mental Health and general practice education teams.
Analysis of the data was supported with the application of radar charts. A radar chart (or star ⁄ spider chart) has an axis for each topic area covered in the survey. The axis extends outwards from a central point, with the value of each data point plotted on the corresponding axis. Radar charts are used in multiples to compare findings and are therefore useful ways of representing multivariate observations, this approach often being taken to establish benchmarks. By establishing patterns (on different radar charts), it can be easier to locate exceptions to the pattern, and as a result, dissimilar findings.11
RESULTS Significant accessible resources of relevance to this training were located within the Royal College of Psychiatry, in the form of e-learning modules. In addition, existing curricular objectives and training materials that were complementary to the context of rural provision, and to the aspirations of this new educational programme, were found
Table 1. Profession of respondents Profession
Expert panel survey n = 13
Mental health nurse
4
Consultant psychiatrist
4
Mental health projects manager
1
Highland user group
1
General practitioner
3
BASICS survey n = 80 1
63
Consultant A&E
1
Resuscitation officer
1
General nurse
3
Paramedic
7
Medical student
2
Nurse practitioner
1
Student nurse
1
386 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
Rating Average - Expert Rating Average - BASICS 1 2.50
21 20
2 3
2.00
19
4
1.50 1.00
18
5
0.50 17
6 0.00
16
7
15
8
14
9 13
10 12
11
Figure 1. Assessment of risk: 1, environmental risks; 2, personal risks; 3, risks to the individual; 4, mental health history; 5, history of the current event; 6, current and future risks; 7, involving the carers and network; 8, keeping yourself safe; 9, support networks; 10, lone working policy; 11, developing supportive networks; 12, significant event analysis; 13, positive risk taking; 14, triage; 15, risk management; 16, ‘at-risk’ register; 17, aggression management theory and practice; 18, deliberate self harm theory and interventions; 19, suicide risk assessment; 20, understanding the risk to others; 21, communication of risk Rating Average - Expert
20
2
4
1.50 1.00
18
5
0.50 6
17 0.00
7
16
8
15
14
9 13
10 12
11
Figure 2. Patient assessment
to have been developed previously by STORM.12
• crisis management;
Seventeen experts from across Scotland agreed to form the expert panel and were interviewed. The following topics were identified:
• engagement skills;
• risk assessment; • patient assessment;
The results of the expert’s survey and the BASICS survey are presented as radar charts in Figures 1–3. Figure 1 is an example of the level of agreement between the expert and BASICS group within each topic area demonstrated in the results. It shows how respondents assessed each of the identified themes and demonstrates that, with the exception of developing an ‘at-risk’ register, both groups agreed on the contents of the topic areas. Figures 2 and 3 demonstrate that in each of the topic areas included in the online survey there was a high level of agreement between the different respondent groups for the contents of the course.
3
2.00
19
Table 1 shows the professional background of respondents to the surveys. Eighty-two per cent of the expert panel responded to the stage-2 online survey, and 23 per cent of the BASICS practitioners surveyed completed the questionnaire.
[There is a] need for more context-specific training opportunities for remote and rural practitioners
Rating Average - BASICS
1 2.50
21
• understanding your care network.
• handling difficult situations;
• mental health law; • management of retrieval; • pharmacology; • theory and classification of mental illness;
CONCLUSION This article demonstrates how consensus over the content of a national course can be achieved through the use of a modified Delphi approach, which, given the different interested groups and diverse agendas, represents a great achievement. There was strong agreement between the expert group and the practitioners in terms of prioritising the content areas. It also highlights the need for more context-specific or inclusive training opportunities for remote and rural practitioners. Stage 4 of the process identified a number of online resources that could be used to
2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388 387
It demonstrates how important it is to design educational programmes that align with government policy
Rating Average - Expert Rating Average - BASICS
1 2.50 13
2
5. NHS Education for Scotland. Evaluation of the Mobile Clinical Skills Unit. 2010. Available at http:// www.csmen.scot.nhs.uk/media/ 1808/evaluationofthepilotofthemo bileclinicalskillsunit2011.pdf. Accessed on 3 April 2013.
2.00 1.50
12
3
1.00 0.50
11
4
0.00
10
5
9
6 8
7
Figure 3. Engagement skills
efficiently deliver some of the knowledge content of the course at a distance. It also demonstrates how important it is to design educational programmes that align with government policy or strategy, provide a national standard and that are inclusive of the needs of health care practitioners in remote locations. One of the remaining challenges is ensuring the continuing development of trainers or faculty staff to deliver the course, as well as leadership in developing and maintaining the course. REFERENCES 1. Dunn P, Cantrell J, Swan G. Mapping Current Educational Provision for Healthcare Professionals in Remote and Rural Areas. NHS Education: 2007. Available at http://www.nospg.nhsscotland.com/wp-content/
skills_strategy_exec_summary.pdf. Accessed on 21 February 2012
25-10_i_Training-Needs-in-MentalHealth-crisis-response-in-rural-Scotland_RRHEAL_2010.pdf. Accessed on 9 April 2012 2. Scottish Executive Health Department. Delivering for Remote and Rural Healthcare: The final report of the Remote and Rural work stream. Edinburgh: Scottish Executive Health Department; 2008. Available at http://www.scotland.gov.uk/ Publications/2008/05/06084423/0. Accessed on 21 February 2012 3. NHS Scotland Final Report of the Remote and Rural Implementation Group. Remote and Rural Implementation Group (RRIG), 2010. Available at http://www.nospg.nhsscotland.com/wp_content/3.Final_ Report_RRIG_Oct10.pdf. Accessed on 21 February 2012. 4. NHS Education for Scotland. Partnerships for Care: Taking Forward the Scottish Clinical Skills Strategy. Executive Summary: 2007. Available at http://www.csmen.scot.nhs.uk/ media/1867/scottish_clinical_
6. Scottish Executive Health Department. Choose Life Strategy and Action Plan. Edinburgh: Scottish Executive Health Department; 2002. Available at http://www.scotland.gov.uk/Resource/Doc/46932/ 0013932.pdf. Accessed on 21 February 2012 7. Scottish Executive Health Department. Delivering for Mental Health: The Mental Health Delivery Plan for Scotland. Edinburgh: Scottish Executive Health Department; 2006. Available at http://www.scotland.gov.uk/Resource/Doc/157157/ 0042281.pdf. Accessed on 21 February 2012. 8. Keeney S, Hasson F, McKenna H. The Delphi Technique in Nursing and Health Research. Oxford: Wiley– Blackwell; 2011. 9. Dalkey N, Helmer O. Delphi technique: characteristics and sequence model to the use of experts. Management Science 1963;9:458–467. 10. Watson R, McKenna H, Cowman S, Keady J. Nursing Research Designs and Methods. Edinburgh: Churchill Livingstone; 2008. 11. Pope C, Mays N, Popay J. Synthesizing Qualitative and Quantitative Health Evidence: A guide to methods. Maidenhead: Open University Press: 2007. 12. STORM. Skills-based Training on Risk Management. Available at http:// www.stormskillstraining.co.uk/ about_storm. Accessed on 18 April 2012.
Corresponding author’s contact details: Fiona Fraser, Remote and Rural Healthcare Educational Alliance (RRHEAL), Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Approval for this work was governed by professional codes of practice, as the article illustrates a clinical practice development ⁄ education. The development of the enquiry that led to the development of the course was also put before the ethics committee at Dundee University, with leadership from Dr Jean Ker, who is based there. doi: 10.1111/tct.12054
388 2013 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2013; 10: 384–388
