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Train the Trainer

       Hello, and welcome to the ImPACTS Outpatient Improvement Collaborative! The goal of ImPACTS is to improve the quality of care delivered to acutely ill and injured children whenever and wherever it is needed. Outpatient offices and general pediatricians are often a vital link in the continuum of pediatric acute care required to achieve this goal.   This continuum includes home, outpatient offices, emergency medical services, emergency departments, and in-patient care. The specific aim of the current project is to improve adherence to the AAP office-based readiness guidelines by 10% in six months. This collaborative involves individuals/teams with a shared interest in improving pediatric acute care working together in a structured program with ongoing interactions and shared resources, tools and experiences.  Members of the collaborative learn from and with each other as they work together towards a shared goal.  This collaborative is coordinated by a central hub/PI that will support hubs (academic medical centers) working together with spokes (pediatric offices).  

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       We are grateful for your team’s plan to participate as a hub.  As a hub you will collaborate with a minimum of two pediatric outpatient spokes in a six-month structured collaboration.  The five phases of this collaborative are:

0 months

6 months

       Our hope is that the relationships formed during the structured 6 month collaboration will continue beyond these initial 5 phases.

       This manual of operations is intended as a guide to help your team understand the intended structure of the collaborative, serving as an explanation and reference for you while planning and conducting this project. We recognize that each site has individual needs and that one size may not fit all. We ask that if you have questions, feedback on this document and/or deviate from the intended structure described here that you notify the core team as soon as possible.  As an improvement collaborative, we have the opportunity to adapt our methodology based on your experiences and feedback.

       Please find the full train-the-trainer document linked below and overviews of the phases linked to the timeline above. Again, thank you for joining this project and for taking interest in improving the care of acutely ill children, no matter where they are.


       Multiple different approaches can be used to recruit spokes to participate in this collaborative. There is no one size fits all strategy, and it often boils down to relationships, persistence and lots of communication with the spoke sites (emails, phone calls, conference calls). Some of the approaches used by ImPACTS include: 

Emailing or cold calling practices

Working with hospital/academic

center liaisons

Personal relationships and colleagues 

Rely on preexisting relationships with community practices

       Once you have recruited a site, your initial conversation and meeting is your chance to sell the project; be enthusiastic and let the practice know how excited you are! It is important to discuss the specifics of the program including goals, objectives, staff and room needed for sim, and equipment needed during the session as well as the overview of simulation day. This is also the time you will designate a Practice Champion, who will serve at the liaison for the site, and the date and time of the simulation session. You can find a more detailed outline for this meeting in hub resources. After the meeting, follow-up with the site regularly via the Practice Champion as the simulation day approaches to ensure everything is in place.

Baseline Office Visit

Baseline Office Visit

       You have made initial contact with your site, recruited them as a spoke, and now it is time for simulation day! We tend to prep two days before the event, giving us enough time to add any additional equipment if forgotten. Plan to arrive approximately one hour before the session start time to meet staff, setup the equipment, and organize the room. Practices often will be behind with patients or work, so you may need to be flexible with your start and end times. 

       We normally conduct the readiness survey on the day of simulation prior to or during the set-up process a. All documents related to sim day, including sign-in sheets, simulation scenarios and checklists, and the readiness survey can be found in the hubs resources for your reference. Scripts for the pre-brief and simulations can be found in the appendix of the full Train the Trainer document. The full day will run for approximately 120 minutes and is organized as follows:

introductions and overview

Who we are, who you are, learning objectives, and how simulation day

will run.

Group discussion

Discuss past experiences and future concerns with level of training and pediatric emergencies.

Orientation, simulation, and debriefing sessions.

Gather feedback, discuss continued training and resources, and plan future communication with site.


Wrap up

       We collect data using video recording of the sessions using Bline and in-person data capture. In-person data will then be entered into the ImPACTS central database via Qualtrics survey, the link for which can be found in hub resources. Evaluation forms should be distributed to all participating members of the Spoke, and a separate evaluation form should be given to the practice manager/champion facilitating the visit. These forms should be collected prior to leaving after the session is complete.

Report Out

Report Out

       Two weeks after the simulation session is the post-session report-out meeting, an exciting time for a discussion of the practice performance and action items for the practice with the goal to improve knowledge, staff awareness, and pediatric outcomes. During this meeting the detailed PowerPoint of the site report-out data is to be reviewed. Please allow for the remaining time to answer questions, along with discussing action items and specific methods to improve the site’s overall case scores.

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Monthly Check-Ins

Monthly Check-Ins


       Monthly check-ins should occur between your team and the practice champion after the initial follow-up visit to keep an ongoing relationship with the site, assess their progress on addressing action items, and as needed, identify further action items which they can improve upon. These check-ins can take place in person, via email, or via teleconference. We suggest scheduling the next check-in during your prior meeting. You should record the dates of these check-ins and any progress made regarding the spoke’s action items, and send this information to for tracking.

Follow-Up Office Visit

Follow-Up Office Visit

       After a 6 month period, your team will return to the practice and repeat the entire process over again, hopefully showing improvement in practice readiness and performance! The same checklists will be utilized again in the follow up simulation at the same office. The presence of the same providers and ancillary staff during the follow up sessions is not necessary, since this program is designed to optimize the overall system of care and not necessarily the individual provider performance.

X-Ray Results

     If unable to complete in person visits due to restrictions from COVID-19 you can collect the follow up readiness survey virtually over a video conferencing platform. This should be done after all follow-up interactions are completed. When entering the data, please choose virtual from the dropdown box. There is an example video located on the sample video page.


 For more resources and information on any aspect of this process, please visit the hub resources section of this website linked here and/or review the full train-the-trainer document linked here. Thank you again for being a part of the ImPACTS outpatient project!

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