Dear Colleagues,

The alarming news recently about various health crises throughout the world, and the implication that teams and health systems need, urgently, to be prepared for such crises, brings to mind an important area of the Royal College’s work: our Practice, Performance and Innovation (PPI) unit. Some Fellows may not be as familiar with this area of our expertise as they with others so I thought it appropriate to devote my August message to PPI’s success and expanding program offerings.

PPI develops programs for physicians and interprofessional health care teams that help them maintain their competence for situations that they rarely encounter in practice. Using simulation-based technology as the basis of its programming, PPI focuses on maintaining communication skills, and improving critical care, decision making and rapid response in unfamiliar situations. PPI has delivered its programming widely within Canada and locations in need around the world, delivering courses that range from acute critical events and end-of-life simulations to simulation educator training.

As one example, our PPI team recently presented a course in Saudi Arabia that helped equip health professionals on the frontlines of the Middle East respiratory syndrome (MERS) outbreak. The work came about after I was contacted personally by the Minister of Health from Saudi Arabia, who was seeking a solution to improving the competencies of health teams dealing with undifferentiated patients. (Such is the Royal College’s reputation internationally that this individual reached out to us for assistance.)

In this case, PPI managed the challenge by customizing a version of its acute critical events simulation (ACES) approach, which is an educational intervention that the unit created following the SARS crisis here in Canada. The inter-professional team of physicians, simulation experts, nurses and respiratory therapists that we deployed to Saudi Arabia to assist with the MERS intervention will return to area at the end of August.

In another recent effort, this one in Nepal, we were asked by the Ministry of Health to upgrade the skills of physicians working in community hospitals so that they can practice critical care. Again, we employed the ACES approach, which we continue to extrapolate internationally.

Programs developed in house

Our PPI unit manages the course-delivery process from start to finish, using its instructional designers to develop course materials according to need and then delivering courses as elements of larger educational strategies. This is an important distinction of our work with PPI. It is not a course “shop”. Its team researches the needs and challenges of complex health systems and utilizes its knowledge as part of larger strategies for bringing about meaningful change in the system.

Accolades for PPI’s Simulator Education Training Course

An example can be found in some work that PPI undertook recently with Northern Medical School. Because of the unique challenges of practising in the North, the school needed to improve the critical urgent skills of individuals transitioning to the GP program. Not uncommonly, GPs in the North must care for critically ill patients for several hours in intensive care units before arrangements can be made to fly the patients to larger facilities. Our PPI team assessed the needs of the program as well as the needs of those teaching the program and embedded the upscaling of learners and teachers into a larger learning strategy for Northern Medical School.

On the scholarly side, the PPI unit is just now finishing a project in Cornwall, Ontario. PPI is examining the challenges of transferring sick people from community hospitals to tertiary care hospitals. Again, the resulting educational intervention will be part of a larger intervention in the area aimed at system change.

Simulation is a proven learning tool

PPI’s method of enabling learning through hands-on training in a simulated work environment promotes deep learning and recall. A large body of research shows that simulated work provides a safe environment for learning and for the team in general—in particular for situations that may be highly stressful or that the team rarely encounters. Most important, many of the technical skills acquired in the simulation lab have been shown to translate into better patient outcomes. The insertion of central lines is one example.

So far, we have had heard extraordinarily positive feedback from our clients about our PPI courses and the practical training that they impart. Our success is largely due to the efforts of the talented and energetic individuals who make up the core team. Dr. Susan Brien MD, MEd, CSPQ, FRCSC, CPE, the Royal College’s director, Practice and Systems Innovation and vice-president Asia Pacific, Royal College International, leads PPI and is credited with having acquired a critical care team for PPI that brings deep experience working collaboratively. Dr. Pierre Cardinal, MD, FRCPC is a critical care leader at the Ottawa Hospital and senior scholar with PPI (as well as being the founder of the Canadian Resuscitation Institute from which PPI was originally formed). Dr. Cardinal oversees the research, development, design and enhancement of PPI’s courses. Angèle Landriault, a critical care nurse, is the new manager of the unit, and Kevin McCarragher is the media expert who helps PPI create the media assets and teaching scenarios that the team takes on the road.

The team includes three simulation educators and a patient safety educator who donate time to help the Royal College encourage Fellows to include simulations in their own training programs. I urge all Fellows to visit PPI’s Web pages and become more familiar with unit and how its course offering can build capacity and significantly improve the level of expertise within teams.

As always, I am eager to hear how Fellows regard the Royal College’s PPI unit and any thoughts you may have about the best ways to move this unit forward. Given PPI’s mandate, what additional (or expanded) program would be most beneficial for your health care team? Perhaps you have a question that we can answer about the benefits of simulation for your practice or workplace. I look forward to your comments and engagement in this important work.


Andrew Padmos, MD, FRCPC, FACP
Chief Executive Officer



Incorporate simulation into your education plan

Candid photos showcasing the PPI unit’s diverse work

Accolades for PPI’s Simulator Education Training Course

“An exceptional course that is simply a must for anyone interested in using simulation for education, and I would highly recommend this course for any clinician educators in general.”
Paul Engels, MD, FRCSC, FACS

“This course was excellent not only in explaining how to do simulation in easy “chewable bites”, but also in placing simulation in its proper context of a curriculum development. I learned more about teaching techniques (particularly debriefing and how to provide feedback to students) than I did in my previous 25 years of teaching students and colleagues.”
Jerome Dansereau, MD, FRCPC, MHSc (Clinical Epidemiology)

“I attended this course during my fellowship in KidSIM at the Alberta Children’s Hospital and it really helped me to organize my thoughts and set a plan of studying, writing, running and debriefing scenarios during my fellowship and hopefully when I return back home to Saudi Arabia.”
Amani Azizalrahman, MD, Emergency Medicine

“I really feel like I have the knowledge and tools to be a better simulation educator after the SET course. I also have great references and a list of go-to people when questions come up!”
Tania Dumont, MD, FRCSC

“An excellent course for anyone involved in simulation-based training. I have worked in simulation for 10 years now and thought I knew everything!”
Louis Gagnon MD, Chicoutimi