RNAO ACPF Simulation Fellowship

Approximately 30% of Canadian newborn males are circumcised (Kim et al., 2019). Yet, formalized training is not available to physicians performing newborn circumcisions, who are in the vast majority non-surgeons (e.g. pediatricians and family physicians) (Demaria et al., 2013). In Canada, physicians often learn from senior colleagues on the job, who invariably also learn the procedure from other colleagues without a structured circumcision-specific training.  As with all urological procedures, newborn circumcision carries risks that include bleeding (1.5-6.5%), adhesions (9.4%), meatal stenosis (2-10%), and rare but devastating potentially preventable complications such as glans and/or penile shaft amputation, necrotizing fasciitis, and death (Salle et al., 2013). 

Data from the Hospital for Sick Children validated the problem of preventable serious complications that have resulted from non-surgical medical consultants performing the neonatal circumcision procedure. For example, 15 patients were admitted with bleeding post-circumcision to the emergency department from 2019-2020, of which 2 patients had penis injuries that required penile amputations. This data validated a potential knowledge and skill gap among the physicians who perform circumcisions with no formal training. As a result, the Urology Department in collaboration with the Simulation Team at SickKids developed and implemented a Circumcision (Training) Using Simulation (CIRCUS) pilot program in February 2021.

The CIRCUS pilot was a 2-day workshop that provided a comprehensive simulation-based training and education related to the neonatal circumcision procedure. The workshop involved multiple phases of training and evaluation that facilitated skills development for 7 Residents and a Nurse Practitioner. The CIRCUS followed an International Network for Simulation-based Paediatric Innovation, Research, and Education (INSPIRE) Procedure Training Framework, which includes six phases: (a) LEARN: preparation; (b) SEE: demonstration from an expert; (c) PRACTICE: simulation-based training with simulator; (d) PROVE: summative assessment on a simulator; (e) DO: clinical performance; and (f) MAINTAIN: assessment of knowledge retention and promotion of continued training/performance (Marc et al., 2014). The INSPIRE framework was used to improve participants’ knowledge, skills, and confidence in performing newborn circumcisions safely. 

My overall learning goal was to increase my leadership skills, as a Simulation Educator, through leading the development of a customized Simulation Based Education (SBE) curriculum on neonatal circumcision. The SBE curriculum was designed to address the knowledge and skill gaps within interprofessional teams that can contribute to preventable harm within neonatal patients. Completing this fellowship, as a result, has increased my knowledge and awareness of current evidence-based practices, which use SBE to improve paediatric patient safety outcomes. In addition, I have increased my knowledge about the theories, content, and processes that facilitate the use of simulation to support teaching and learning among interprofessional team members at SickKids. For example, I have developed simulation scenarios, operated simulators (e.g. SimPad/ High Fidelity mannequins), and incorporated SBE to assess, teach, debrief, and evaluate interprofessional learners. Lastly, I have gained the essential project management skills imperative to keep all aspects of the CIRCUS pilot project organized, which included initiation, planning, execution, and management of all project deliverables in a timely manner.