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Education The Seat of Medical Education

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Background

A Brief History



The Background


The idea of structured training in cardiopulmonary resuscitation (CPR) skills for our healthcare providers is an old one. It goes as far back as the mid-1980’s when Singapore General Hospital was operating under the Ministry of Health (MOH). A cardiac rehabilitation program of the Hospital was able, with the availability of medical mannequins at that time, to commence structured CPR training for clinicians with makeshift premises borrowed from the former Physiotherapy Department.

SGH underwent corporate restructuring in 1989. With the setting up of National Heart Centre in the Outram Campus in 1994, the facilities for CPR training improved. The coordination and administration of the CPR training programs was then under the Hospital’s Education and Training Department. During the period, medical subspecialty training was developing and Emergency Medicine received increasing emphasis. This provided the impetus for continually upgrading our doctors’ skills and knowledge in the emergency management of patients with cardiac arrest. At the same time, the medical fraternity worldwide was increasingly attuned to the educational approach of acquiring clinical skills through a “laboratory” environment.

By mid-1990 a concerted effort was made by the Accident and Emergency Department to search for a dedicated training venue for the purpose of conducting formal life-support courses. The old deserted building vacated by the former Radiotherapy Department was identified and refurbished.

Inception of a Training Centre

In March 1999, the SGH Life Support Training Centre came into existence. Mr. Lawrence Lim, the Chief Executive Officer, and Prof. Tan Ser Kiat, the Chairman of the Medical Board officially opened it. The Life Support Training Centre, abbreviated as “LSTC” was initially run by a team of three staff with Ms. Madhavi Suppiah as the Manager, an instructor and an administrative assistant. Operationally, the Centre came under the auspices of the Division of Ambulatory and Clinical Services.

Official Opening of the SGH Life Support Training Centre


The two earliest educational programs conducted by LSTC were the Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) courses. The BCLS was essentially a course in cardiopulmonary resuscitation structured for both the healthcare professional and the general public alike. It consists of a number of life-saving techniques that focus on the ABC’s (Airway, Breathing, Circulation) of pre-hospital care. On the other hand, the ACLS is targeted for medical practitioners working in hospitals. It teaches a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions in the hospital setting. Both courses were structured to follow the guidelines of the International Liaison Committee on Resuscitation (ILCOR).

Learning Cardiac Defibrillation In ACLS

Demonstrating External Cardiac Massage



In addition to the BCLS and ACLS, other life-saving training activities were customized. In 2000, the Automatic External Defibrillation (AED) Course was introduced for those members of the public who may have the need or opportunity to use the cardiac defibrillator in handling acute cardiac emergencies as part of their job function or daily routines. This eventually morphed into the more comprehensive CPR + AED Provider Course, which has since proved very popular with trainees from many organisations, including hotels, uniformed groups, banks and sports associations.


Milestones


In 2001, significant educational developments took place. LSTC started to conduct the International Trauma Life Support (ITLS) Course. ITLS is a global organization dedicated to preventing death and disability from trauma through education on pre-hospital trauma care. The Course is designed primarily for ambulance officers and paramedical personnel who have the responsibility of attending to trauma victims at the site of the accident and transporting them safely to the nearest hospital emergency service.

Immobilizing The Trauma Victim In ITLS Training



Awareness of the need for managing mass disaster increased. In the same year, on behalf of MOH, a group of Emergency Medicine doctors developed a two-day HAZMAT Basic Provider Course. This course focused on the fundamental principles of disaster preparedness for personnel involved in managing mass casualties, and has since been conducted yearly for participants from MOH.

In 2001, the Society of Intensive Care Medicine (SICM) in Singapore brought in the Fundamentals of Critical Care Support Course (FCCS) and LSTC was tasked to help in its delivery. It is a comprehensive 2-day course, the content of which is prepared by the American Society of Critical Care Medicine. The course addresses the fundamental principles of management in the first 24 hours of the critically ill patient until appropriate critical care consultation can be arranged. The course content and format have been developed by the American Society of Critical Care Medicine with the objective of assisting the non-intensivist physician to deal with sudden deterioration of the critically ill patient. The course is currently run about 5-6 times a year and is popular with trainees from Anaesthesiology, Critical Care and Emergency Medicine.

In 2004, the Fundamentals of Disaster Management (FDM) Course followed. It was a logical addition to the highly successful FCCS Program and was launched after the worldwide reaction to the 9/11 Attacks. It was prepared under the direction of the Society of Critical Care Medicine (America) and by leading multi-disciplinary critical care professionals with expertise in disaster preparedness.

In tune with the JCI hospital accreditation movement, SingHealth decided in 2005 that all new medical graduates from the NUS School of Medicine would undergo compulsory ACLS certification before commencing Housemanship in its hospitals. LSTC was the designated training centre and tasked with the responsibility of certifying all new house-officers.

Compulsory House-Officers Training for ACLS
 


Growth


In August 2007, LSTC shifted its premises to Connection One in Jalan Bukit Merah to pave the way for the construction of the Pathology, Education & Research Building.

In the new premises, three Emergency Care Simulators (ECS) from Medical Education Technologies Inc (METI) have been installed. These simulators are “intelligent” medical mannequins that incorporate electronic feedback systems based on highly developed human physiological models. The advantage of using these simulators in medical education is that they generate realistic and automatic responses to clinical interventions and drug administrations. These sophisticated built-in systems capture the complexities of human physiology with heart and breath sounds, palpable pulses with a myriad of other features that mirror a true and accurate representation of the human body. Using pre-programmed scenarios, medical teachers in LSTC are now able to create real life clinical drama in a classroom environment for the first time.

The First Patient Crisis Simulation Workshop was held in the premises in Connection One in August 2008. It marked a new era in simulation-based learning. Participants were made to each go through a clinical scenario as members of a rapid-response team. The learning was experiential and involved skills in clinical decision-making and team communication. Its initial success led to a follow-up event, the 2nd Patient Crisis Simulation Workshop being held in Feb 2009. It attracted participants from the Singapore Armed Forces and practitioners from the private hospitals. The Academy of Medicine, Singapore has since recognized the enormous potential of medial simulation in specialist training and have requested for the 3rd Patient Crisis Simulation Workshop to be incorporated into their 43rd Singapore-Malaysia Congress of Medicine in Aug 2009.

Arrival of the METI Patient Simulator 2007

Patient Crisis Simulation Exercise



Dr. Steven Mather, Consultant Anaesthetist and HMDP Expert from Bristol Medical Simulation Centre, conducting a simulated patient scenario at the LSTC simulation control room on 8 Jan 2008


Alongside the growth of medical simulation, another educational development has been taking place. Since 2007, a team of 3 doctors from the Emergency Medicine Department of SGH & NUH has been working closely with LSTC to develop the highly successful Emergency Airway Management Course (EAMC). It is a 2-day intensive course that imparts the skills of managing difficult airway problems in patients under different clinical situations. The Course has turned out to be extremely successful and since attracted many Emergency Medicine Trainees.

Throughout the years, LSTC has not forgotten its role in its outreach to the wider public community. It continues to organize First Aid programs, public forums and CPR awareness programs for the public, including secondary schools and Community Centres.

Community First Aid in Raffles Girls School
 


Singhealth’s Women Forum 25 Mar 2007

Cheng San Community Centre Event 17 Sep '06


New Development


With the rapid expansion in training activities comes the need for new directions in pedagogical development. LSTC in journeying through a new phase in which the need for Educational leadership is acutely felt. A new position of medical directorship of LSTC has been proposed by the Division of Ambulatory and Clinical Services and since approved by Prof Ang Chong Lye, CEO & Prof Ng Han Seong, Chairman, Medical Board. Dr. Peter Mack has been formally appointed as Director of Life Support Training Centre from 1st May 2009.


Last Modified Date :11 May 2010