By Adam
Dubrowski
Introduction
Together,
with a group of my Canadian colleagues from Calgary, Alberta (some via Doha) and
London, Ontario I was privileged to represent MUN’s Faculty of Medicine during
the first Train the Trainer in Simulation-Based Learning (TTT-SBL) program in
Mzuzu Central Hospital and Mzuzu University in Malawi. Our team, led by Elaine Sigalet (Doha) and
consisting of Ian Wishart (Calgary) and Faizal Haji (London), was invited to
Malawi by Norman Lufesi, to conduct a 2-day TTT-SBL course for facilitators who
teach an Emergency Triaging, Assessment of Trauma (ETAT) course.
The TTT-SIM facilitator
team (from left to right): Adam Dubrowski, Elaine Sigalet, Norman Lufesi, Ian
Wishart, and Faizal Haji.
Why?
This
course was developed in response to an evolving partnership between the
International Pediatric Simulation Society (IPSS), the World Federation of
Pediatric Intensive Care Societies (WFPICCS), and the Ministry of Health. The
long-term objective of this partnership is to decrease pediatric morbidity and
mortality through the introduction of context specific faculty development
programs focused on pedagogy and administration of simulation programs. It is
anticipated that such programs will lead to the improvement of on-going health
care educational efforts and the development of effective future programs,
subsequently improving health service delivery for patients in Malawi.
What?
This was our
third visit to Malawi. The first, in
2012, was primarily an environmental scan for us to understand the health care
system as a whole and to listen to the relevant stakeholders about their needs
for simulation. Together with the Malawians,
we identified that their on-going ETAT course would provide the right context for
implementing simulation-based learning (SBL).
The second visit in 2014, consisted of observations of ETAT courses and
mapping the TTT-SBL course. Our most
recent visit’s purpose was to implement the TTT-SBL course and to observe how
the newly trained facilitators performed.
Norman Lufesi,
who works for the Malawi Ministry of Health and is responsible for delivery of
the ETAT courses in Malawi, had a vision for revising the current format of the
ETAT to include more simulation.
Although elements of simulation are already used during the ETAT, he
articulated that there are a number of shortcomings. First, the local ETAT facilitators are not
trained in how to use simulation effectively.
Secondly, the simulation that is used focuses on the development of
technical skills by an individual health care professional. Finally, the course
now is mainly 4.5 day long filled with didactic lectures. Norman strongly believes that ETAT should
also focus on the development of team-based learning, specifically elements of
leadership, team communication, and resource management. In his opinion, improving the teaching skills
of the facilitators, and adding team training as part of the ETAT course
offerings will make the course more effective and shorter (aiming at 2.5 days). He adds that at this moment ETAT is a
multi-professional course, where nurses, doctors, and clinical officers work in
collaboration with each other. By including
team-based training, Norman hopes that the course will become an inter-professional
course where all these health professions will learn with and about each
other. Furthermore, in his vision Norman
hopes that this shift towards inter-professional education will cascade into
inter-professional practice, ultimately leading to improved clinical outcomes.
Over the past
2 years, our group focused on the development of a 2-day TTT-SBL course. The scope of this course includes providing
the fundamental knowledge and skills necessary to prepare learners for SBL, for
designing and running simulations, and for providing proper debriefing and
feedback. During the course the learners
were provided with ample opportunities to actively implement the newly gained skills
and knowledge. The inaugural TTT-SBL course,
conducted in September 2016, was strategically timed just prior to an ETAT course,
where the newly trained facilitators were able to test their simulation
teaching skills with 30 ETAT learners. In
the spirit of experiential learning and deliberate practice, the Canadian team
hung out until the end of the course to provide these new ETAT facilitators
with feedback.
The TTT-SIM
facilitators, ETAT facilitators, and the cohort of the Mzuzu ETAT students.
But our work
is not done yet! Together with Norman,
the Canadian team has committed to a long-term mentor-ship plan that includes
four initiatives. First, the Canadian mentor
team has re-written one of the modules of the current ETAT course to minimize
the amount of didactic lectures, and when appropriate, to provide more
simulation experiences, especially in the areas of critical thinking,
leadership and team work. Next, as a
follow-up exercise, the newly trained ETAT facilitators have been tasked with re-writing
the other modules of the ETAT course.
Third, the facilitators were asked to produce a TTT-SBL manual and
supporting materials that can be used as a local resource for future TTT-SBL
courses. Finally, the facilitators were
asked to establish a group of dedicated individuals to formulate a process for organizing
TTT-SBL courses in other parts of Malawi and conduct a review of the existing
materials.
Two way street
Working on
and delivering the TTT-SBL made me realize the parallels between Malawi and
rural and remote Newfoundland. Our
problems are very similar. Rural and
remote areas do not have access to high fidelity, high technology simulation. Even with low tech substitutes, the health
care professionals may lack the educational skills to make it most effective,
and finally these health care professionals are often the only ones available
to the local patient population and taking them away from their patients can be
hard. Is there a role for a version of
this 2-day TTT-SBL course in rural an d remote Newfoundland?
I left Malawi
with mixed feelings of being home sick and longing for more - the excitement
and energy during both the TTT-SBL and the ETAT courses were very stimulating
and rewarding. But, I know this will not be my last trip to Malawi.
Acknowledgments: I would like to thank
the Tuckamore Simulation Research Collaborative, and the Dean’s office for
supporting this work. I would also like to thank the other members of our team
for making this happen!
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