Currently, 564,000 Canadians are living with dementia. This number will continue to rise as the population ages. Family physicians play an integral role in the diagnosis and management of dementia patients. Although studies have looked at family physician perspectives on dementia care in the urban setting, much less is known about challenges in rural areas. This study aimed to explore rural family physicians’ experiences in caring for patients with dementia in rural Alberta, Canada. We conducted three semi-structured focus groups with 16 family physicians to evaluate barriers and facilitators to providing care to persons with dementia in three rural communities. We developed focus group questions based on the theoretical domains framework (TDF) and analysed them using a framework approach. Physician capabilities, opportunities, and motivations appear to play important roles in caring for these patients. These research findings can be used to advance quality of care for rural dementia patients.

Introduction/Innovation Concept: Rural and remote practice of emergency medicine presents unique challenges, particularly when faced with infrequently encountered cases and procedures. Simulation-based training is a valuable tool in the acquisition and maintenance of knowledge and skills; however, simulators are often located in larger centers and they are not widely outside these centers due to geographic, cost and time constraints. Mobile tele-simulation has the potential to overcome barriers but challenges such as comfort, technical issues and ability to teach desired content via tele-simulation must be addressed. We are developing a mobile-tele-simulation unit (MTU) prototype that will enable emergency medicine practitioners and trainees to access simulation-based instruction in rural and remote settings. Methods: Through application of a mixed-methods approach with input of a multidisciplinary team we are iteratively developing an MTU prototype to assess key factors in design and function, including: technical issues, environmental features, and human factors. The Delphi method is being used to collect input from experts on key design components and feedback is also being collected from trainees after participating in trial deployments of the MTU in different educational and environmental settings. Curriculum, Tool, or Material: The effective application of the MTU in a variety of learning settings will be optimized through ongoing evaluation in the iterative design cycle. Feedback to ensure a quality learning experience in the MTU will direct features of physical design and technical performance that can be applied in deployment of the unit. In addition, challenges to the delivery of module content and instructional modality/ features of lessons to be executed will be important considerations as we move toward developing content that can effectively be taught using the MTU. Conclusion: To ensure effective use of tele-simulation in the delivery of a meaningful simulation experience to rural and remote trainees a number of important challenges must be overcome. We describe our evolving multidisciplinary mixed-methods approach to develop an effective mobile tele-simulation unit.

Introduction / Innovation Concept: Skillful performance is central to the provision of quality healthcare. Well-organized, deliberate practice with instruction and feedback leads to the best learning and patient outcomes. Professionals in rural/remote locations often face significant challenges in maintaining procedural proficiency and delivering acute care medical services. This is especially important with low-frequency high-stakes procedures. Simulation can play an important role in skills maintenance but limited access to simulation labs and resources in rural areas due to time, cost and distance are often prohibitive. Mobile telesimulation has the potential to facilitate high-quality instruction and overcome these barriers. Our goal is to develop a mobile simulation unit (MSU) that uses acute-care telemedicine mentoring techniques to meet the needs of rural physicians. Methods: The MSU design process is a prototype development series with qualitative results from each prototype (A and B) informing design and development of the next. This serves as an assessment of the functionality and set-up of the MSU for housing the simulation equipment/mannequin and providing an acceptable learning environment. The final design (C) will be evaluated for educational effectiveness. Medical students will be taught endotracheal intubation on a mannequin in the MSU under one of 2 conditions. The experimental group will receive instruction, demonstration and feedback from an expert in the telesimulation lab at Memorial University. The control group will receive the same instructions and feedback face-to-face from an expert located in the MSU. Participants will complete a retention test 1 week after the intervention. Performance between the 2 groups will be compared and user satisfaction will be assessed. Curriculum, Tool, or Material: The MSU will be a portable, inflatable structure equipped with telecommunication equipment to provide efficient interaction between the rural/remote learner and their instructor at a different site. The design and components of the MSU will facilitate easy transport and deployment for telesimulation in rural/remote areas. A combination of fixed and wearable cameras will facilitate instruction, demonstration and feedback to the learner. Conclusion: Mobile telesimulation may play an important role in overcoming the barriers of geography, cost and access to expert instruction. Implications of this research are far reaching and extend beyond healthcare education and training.