Dubrowski 1 SSE

TEACHING THE TRAINERS IN SIMULATION BASED EDUCATION:

BARRIERS AND SOLUTIONS

Dubrowski A., Miliard Derbew, Byrne N., Pittini R., Satterthwaite L., and Tajirian T.

Roger Kneebone Alison Barnet

Fernando Bello 

 Supported by DelPHE

EthiopiaMaternal mortality ratio in 2005 (lifetime risk of maternal

death) was 1 in 27

720 of every 100,000 births result in maternal death.

Canada• Maternal mortality ratio in 2005 (lifetime risk of maternal

death) was 1 in 11,000, and 7 of every 100,000 births result in maternal death.

EthiopiaMaternal mortality ratio in 2005 (lifetime risk of maternal

death) was 1 in 27720 of every 100,000 births result in maternal death.

Canada• Maternal mortality ratio in 2005 (lifetime risk of maternal

death) was 1 in 11,000, and 7 of every 100,000 births result in maternal death.

• The World Health Organization (WHO) estimates that the majority of fatalities and disabilities could be prevented if deliveries were to take place at well-equipped health centres, with adequately trained staff.

• Guilbert JJ. The World Health Report 2006: working together for health. Educ Health (Abingdon). 2006;19(3):385-7.

• The goal of a partnership between Addis Ababa University, University of Toronto, and Imperial College London is to develop a sustainable plan for training cohorts of educators capable of developing and evaluating training programs in technical skills related to surgery [trauma], gynecology & obstetrics (OBGYN), nursing and midwifery using simulation.

 simulation

Replication of a task or an event for the purpose of training or evaluation

November 2006Medical Education, 2009

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• In November 2008 a group of individuals representing the three partners conducted an extensive environmental scan and stakeholders analysis in order to set an agenda for the upcoming 3-year funding period.

• Three primary objectives during this meeting were: a) To identify current use of simulation resources in the Surgical

Simulation Laboratory (SSL, The Black Lion hospital, Faculty of Medicine, Addis Ababa University),

b) to identify potential areas for faculty development (Train the Trainer) programs to enable optimal use of the SSL, and

c) to develop a plan for Train the Trainer program and its implementation.

Methods:  • The group met with four groups of stakeholders:– Trainees from medicine, surgery, OBGYN, nursing and

midwifery – current and potential users of the SSL,– faculty members from medicine, surgery, OBGYN, nursing and

midwifery – current and potential users of the SSL,– university governance,– external stakeholders: CINS, and British Council.

• The group also visited the site and participated in a training session in the facility.

Results:  • The undergraduate medical program and surgical residency

utilize the SSL extensively by:

– Following the Essentials of Surgical Skills (ESS),– providing self-guided learning opportunities to students,– providing special skills training (e.g., laparoscopic skills)– encouraging other departments including OBGYN, nursing and

midwifery to become involved in skills training courses.

Results:  • Four significant areas for future development were identified:

– Development and implementation of reliable and valid learner assessments,

– Implementation of learner-centered educational approaches,– implementation of more realistic forms of simulation training,– shift towards inter and multi professional simulated training.

Conclusion:The collective expertise within the partnership group will be applied to

the development of Train the Trainer program aimed to expand on skills necessary to plan, implement and assess simulation-based courses offered to the medical students, surgical residents, OBGYN residents, nurses and midwifes.

Planned activities:  • Year 1: “This is how we do it”

– March 2009: Train the Trainer workshop– March 2009: Independent research studies indentifying

institutional facilitators for the progress and the effectiveness of the program (Drs. Maisam Fazel).

Planned activities:  • Year 2: “Now it is your turn”

• A selected group will be asked to re-develop the workshop (objectives simulation evaluation)

• Tangible outcome: Train the Trainer Guidebook • 2-day module in advanced assessment in evaluation and new

simulation approaches (contextualized simulation).

Planned activities:  • Year 3: “Sustainability”

• Evaluation of the program. • Exporting the program to other schools in Ethiopia and Sub-Saharan

Africa.

• In March 2009 a group of individuals from Toronto lead a 3 day hands on Train the Trainer course on simulation-based program development and performance assessment.

Summary:  

• The course was graduated by 12 clinicians and 2 administrators. • UTAASC was formed.

Inactivity

External factors• Lack of follow up from us

Internal factors• Top down rather than bottom up process

Next steps (November 2009):  

• Distribution of a source book• Development of a guide book• Environmental re-scan and stakeholder re-analysis• Assign specific roles

Next steps (November 2009):  

• Distribution of a source book

Next steps (November 2009):  

• Development of a Guide book

– Basic Technical Skills [e.g. Suturing, IV Catheterization]– Perineal Tear Repair– Instrumental Delivery– C-section– Abortion Care

Next steps (November 2009):  

• Environmental re-scan and stakeholder re-analysis

Infrastructure: Skill labinanimate and animal modelsinstructional videos

Faculty:Interest of the faculty and leadership in the labStrong support from department members to have the curriculum designedStrong interest by faculty and department headInterdepartmental cooperation

Students:Interested studentsExpanding post graduate program

Infrastructure: Skill labinanimate and animal modelsinstructional videos

Faculty:Interest of the faculty and leadership in the labDedicated staffStrong support from department members to have the curriculum designedStrong interest by faculty and department headInterdepartmental cooperationYoung surgeons who have good energy

Students:Interested studentsExpanding post graduate program

Infrastructure:Financial constraint/BudgetSingle and small skills labLimited resources and timesAccessibility to all staff 24/7 Faculty and staff:ManagementLimited and untrained staffLess advertised even within facultyPoor linkage Incentives for faculty members Program:Absence of well-structured programUnder-developed curriculum

Infrastructure: Skill labinanimate and animal modelsinstructional videos

Faculty:Interest of the faculty and leadership in the labDedicated staffStrong support from department members to have the curriculum designedStrong interest by faculty and department headInterdepartmental cooperationYoung surgeons who have good energy

Students:Interested studentsExpanding post graduate program

Infrastructure:Financial constraint/BudgetSingle and small skills labLimited resourcesAccessibility to all staff 24/7Lack of time Faculty and staff:Management, committed support staffLimited and untrained staffLess advertised even within facultyAdministrationPoor linkage (duplication)Incentives for faculty members Program:Absence of well-structured programLess developed curriculum

Collaboration with other skills labsPartner with external institution like U of T, Imperial CollageFavorable policy and commitmentHuge inter/intra networkingExpanding and diversity of graduate studiesSupport from grants [e.g., DelPHE]Support from CNIS

Infrastructure: Skill labinanimate and animal modelsinstructional videos

Faculty:Interest of the faculty and leadership in the labDedicated staffStrong support from department members to have the curriculum designedStrong interest by faculty and department headInterdepartmental cooperationYoung surgeons who have good energy

Students:Interested studentsExpanding post graduate program

Infrastructure:Financial constraint/BudgetSingle and small skills labLimited resourcesAccessibility to all staff 24/7Lack of time Faculty and staff:Management, committed support staffLimited and untrained staffLess advertised even within facultyAdministrationPoor linkage (duplication)Incentives for faculty members Program:Absence of well-structured programLess developed curriculum

Collaboration with other skills labsPartner with external institution like U of T, Imperial CollageFavorable policy and commitmentHuge inter/intra networkingExpanding and diversity of graduate studiesSupport from grants [e.g., DelPHE]Support from CNIS

BudgetCompetition within and between facultiesBrain drainIT facilities and Internet access Lack of incentivesLack of adequate monitoring

Infrastructure: Skill labinanimate and animal modelsinstructional videos

Faculty:Interest of the faculty and leadership in the labDedicated staffStrong support from department members to have the curriculum designedStrong interest by faculty and department headInterdepartmental cooperationYoung surgeons who have good energy

Students:Interested studentsExpanding post graduate program

Infrastructure:Financial constraint/BudgetSingle and small skills labLimited resourcesAccessibility to all staff 24/7Lack of time Faculty and staff:Management, committed support staffLimited and untrained staffLess advertised even within facultyAdministrationPoor linkage (duplication)Incentives for faculty members Program:Absence of well-structured programLess developed curriculum

Collaboration with other skills labsPartner with external institution like U of T, Imperial CollageFavorable policy and commitmentHuge inter/intra networkingExpanding and diversity of graduate studiesSupport from grants [e.g., DelPHE]Support from CNIS

BudgetCompetition within and between facultiesBrain drainIT facilities and Internet access Lack of incentivesLack of adequate monitoring

Next steps (November 2009):  

• Assign specific roles

• Program: UTAASC – DelPHE• Director: Dr. Fekadesilassie Henok • Patron: Dr. Dawit Desalegn

Director: Dr. Fekadesilassie Henok

1. Chair the UTAASC Curriculum Committee2. Ensure that the UTAASC Curriculum has regularly scheduled

meetings with an advanced agenda and recorded and approved minutes of each meeting.

3. Facilitate the individual course participants in completing course planning, implementation and evaluation.

4. Ensure that each course participant completes an evaluation.5. Act as the key link between the DelPHE Team and the participants.6. Report regularly with the DelPHE Team on course progress and

accomplishments.

Patron: Dr. Dawit Desalegn

1. Oversee the UTAASC Project in Addis2. Report twice yearly to the DelPHE Team regarding project progress

and accomplishments.3. Meet regularly with the UTAASC Course Director to review project

progress and accomplishments. 4. Provide counsel and direction, if requested, to the UTAASC Course

Director.5. Facilitate communication through Dr. Miliard Derbew between the

British Council in Addis and the DelPHE Team.

Summary:  Inactivity

External factors• Lack of follow up from us

Internal factors• Top down rather than bottom up process

Summary:  Inactivity

External factors• Lack of follow up from us

• Source book distributed

Summary:  Inactivity

Internal factors• Top down rather than bottom up process

• SWOT analysis• Guide book in preparation• Governance of the program established

Significance:  

• With proper implementation, this program will create cohorts of local trainers proficient in using simulation for training of clinical skills.

• This proficiency will lead to self-sustainable programs with Ethiopian and Sub Saharan appropriate content and methods.