Table 5 Results from the interviews of the crew members with code groups, subgroups, meaning units and quotations shown

Facilitator

Availability

Availability

Interviewees described the challenges to incorporate time to facilitate into a busy working schedule. 10 am is mentioned as a good time for starting training. One facilitator occasionally found it difficult to go onto a mission in the case that it would interfere with parents following their child during an incubator transport.

Timing

Pedagogical

Pedagogical challenges

Participants describe joining a live mission as more challenging than conducting the simulation and feel that experience is vital for that role. It is also mentioned that it can be a challenge to comment on habits that colleagues have used for decades. On some occasions, facilitators felt it was difficult for ambulances to know whom to interact with.

Experience

Role

Role

It is essential for the facilitator to be able to observe and not participate in the mission, and facilitators need to “know their place” and preferably wear an observer west. Important to keep the role as facilitator and not start any talk about the mission or simulation outside the participating crew.

Trust

Background

Facilitator background

The facilitator does preferably have local knowledge, and it is even mentioned that several local HEMS physicians could be trained as facilitators and go on missions with others. For some, the thought of management or external facilitators riding along on a mission is frightening, whereas others suggest that this is a chance for external feedback. Overall, there is scepticism to having facilitators coming from the management group.

Selection

Skills

Communication

Interviewees agree on the importance of right skills for the facilitator. This includes having a genuine interest, clinical experience and good communication skills as well as and local knowledge.

Interest

Local knowledge

Training

Frequency

Frequency of training

Some participants mention a training frequency of once a week, and at least once a month.

Motivation

Motivation

Both facilitators and crew participants report a high level of motivation among the participating crews, although it did vary.

Variation

Organisation

Organised into service

The support from the management is mentioned as necessary. There are wishes for getting such training organised into the Norwegian HEMS services. The general acceptance and priority of training are noted.

Management support

Outcome

Peer feedback

Peer feedback

Participants report the usefulness of feedback from a (participating/facilitating) colleague. This is seen as an exchange of experiences rather than top-down teaching that often has been practised in traditional teaching.

Difficult cultures

Communication

Correction of habits

Impractical habits feedback

Some participants mention this as an arena where not only communication in general, i improved, but even tricky topics in a challenging crew composition are easier during simulation than during regular workdays. Since most HEMS crews are alone on a mission, this is seen as an opportunity to get feedback and suggestion for improvement of minor daily mission details.

Everyday topics

Practicalities

Longitudinal learning

Longitudinal debrief

In this form for training, participants mention that it is a possibility that they do not receive feedback on all aspects of a mission. This includes not only the clinical part but also the planning phase and choice of equipment brought on the mission.

Comparison

Simulation

Artificial setting

It is described that it is easier to have a planned debriefing structure during the simulation training. More challenging to facilitate mission observation. The simulation gives rise to train rare events as well as optimising the handling of frequent challenges. The predictability of simulation regarding the debriefing topics is essential. The trust among the crew in simulation is mentioned. Simulation can feel more as an artificial setting.

Simulate rare/frequent events

Debrief structure

Predictability

Mission

Anxiety

Some participants have been nervous before having someone observing them on a mission; however, they describe this as a positive experience regardless. This form of supervision is beneficial. It is found stressing but at the same time; they learned a lot. Some are more worried about exposure but like to get feedback. Participants meant this leads to improved performance of them as individuals and for the team.

Performance improvement

Supervision

Planned vs unplanned

Peer feedback

Comparison

Choice

Interviewees agree on the usefulness of both simulation training as well as having one observing them on a mission, although it can feel intimidating initially. There are pros and cons to both training forms.

anxiety

No difference

Different outcomes

Priority/Choice

Mission

Participants explain that they think both forms for of training have a role in the Norwegian HEMS services. Interviewees would like to have both forms of training integrated into the service. If to choose, some distinctively prefer having one accompanying them on a mission.

Both forms