Running in-person clinical scenario simulations are a great learning tool but require a significant amount of resources in terms of materials, trainers, and space – not to mention the challenge of getting all of the key players in the same place at the same time. An inter-professional team from Duke’s Human Simulation and Patient Safety Center (HSPSC) knew there had to be a more efficient way to implement and scale such training. As part of a SEAD research grant, they recently took their proposed solution to Uganda for proof-of-concept testing.
An inter-professional team from the Human Simulation and Patient Safety Center (HSPSC) recently traveled to Mulago Hospital in Kampala, Uganda, as part of a global health education program. The initiative, funded by Social Entrepreneurship Accelerator at Duke (SEAD), was focused on delivering postpartum hemorrhage education using screen-based simulation. This proof-of-concept, using multi-player screen-based simulation, is meant to address gaps in care and to decrease disparities in healthcare education.
The long-range goal of the program is to establish a means for simulation training across continents. The goal of this trip was to train local champions who could sustain the program. Over the course of a week, Ugandan learners (including midwives, anesthesia providers, nurses, and physicians) participated in the inter-professional simulation focusing on teamwork and communication in the context of postpartum hemorrhage.
The success of the program was highly dependent on the diversity and passion of the team, both in Uganda and in the U.S. The project required support from simulation experts, anesthesia providers, computer scientists, nurses, and obstetricians both in the U.S. and in Africa.
One recurrent question was whether the learners would accept and the hospital infrastructure would support our software. The Ugandan trainees embraced every aspect of the training, including the technology. Some learners were tech-savvy while others sheepishly admitted they had never used a computer. Despite the learning curve being different for each trainee, everyone remained intently focused on the learning objectives. Even those with no computer background learned new skills that would be useful to them in practice.
Prior to our trip, we identified many potential barriers to our success: inadequate computer infrastructure, potential interruption of power or Internet connection, potential damage to computer equipment in austere environment, poor acceptance of technology by Ugandan learners, and work responsibilities that would usurp the time of the training sessions. It was critical to consider each of these situations in advance and come up with contingency plans prior to our departure from the U.S. The planning time was well spent, as we had to institute many of our contingency plans while in Africa. These on-the-fly changes included: moving to different computer lab, moving from the wired to the cellular network, purchasing additional network airtime, and borrowing compatible equipment. Although we planned for many contingencies, the project still required team members on the ground to think quickly and creatively on their feet.
Perhaps the most important lesson learned was the amount of time needed to navigate an international IRB. We budgeted approximately three months of time to obtain IRB approval in Uganda. Three months was not enough. With future projects, we would reserve at least six months of time to obtain international IRB approval (and thus were only able to obtain part of the data we hoped to obtain while abroad). Despite this challenge, we were rewarded with lots of positive feedback from Ugandan trainees and a crew of local champions that are interested in continuing the project long-distance.
We are thankful to our counterparts at Mulago Hospital in Uganda, without whom none of this work would have been possible or worthwhile, and to SEAD (and USAID) for their belief in our vision.
The long-range goal of the program is to establish a means for simulation training across continents. The goal of this trip was to train local champions who could sustain the program. Over the course of a week, Ugandan learners (including midwives, anesthesia providers, nurses, and physicians) participated in the inter-professional simulation focusing on teamwork and communication in the context of postpartum hemorrhage.
The success of the program was highly dependent on the diversity and passion of the team, both in Uganda and in the U.S. The project required support from simulation experts, anesthesia providers, computer scientists, nurses, and obstetricians both in the U.S. and in Africa.
One recurrent question was whether the learners would accept and the hospital infrastructure would support our software. The Ugandan trainees embraced every aspect of the training, including the technology. Some learners were tech-savvy while others sheepishly admitted they had never used a computer. Despite the learning curve being different for each trainee, everyone remained intently focused on the learning objectives. Even those with no computer background learned new skills that would be useful to them in practice.
Prior to our trip, we identified many potential barriers to our success: inadequate computer infrastructure, potential interruption of power or Internet connection, potential damage to computer equipment in austere environment, poor acceptance of technology by Ugandan learners, and work responsibilities that would usurp the time of the training sessions. It was critical to consider each of these situations in advance and come up with contingency plans prior to our departure from the U.S. The planning time was well spent, as we had to institute many of our contingency plans while in Africa. These on-the-fly changes included: moving to different computer lab, moving from the wired to the cellular network, purchasing additional network airtime, and borrowing compatible equipment. Although we planned for many contingencies, the project still required team members on the ground to think quickly and creatively on their feet.
Perhaps the most important lesson learned was the amount of time needed to navigate an international IRB. We budgeted approximately three months of time to obtain IRB approval in Uganda. Three months was not enough. With future projects, we would reserve at least six months of time to obtain international IRB approval (and thus were only able to obtain part of the data we hoped to obtain while abroad). Despite this challenge, we were rewarded with lots of positive feedback from Ugandan trainees and a crew of local champions that are interested in continuing the project long-distance.
We are thankful to our counterparts at Mulago Hospital in Uganda, without whom none of this work would have been possible or worthwhile, and to SEAD (and USAID) for their belief in our vision.
About the authors:
Megan Foureman, CRNA, has been a CRNA at Duke for nearly five years, and in 2012 was awarded the Duke CRNA Peer Service award for her formation and oversight of the Duke CRNA Global Health Committee and her volunteer work at the Albert Schweitzer Hospital in Deschapelles, Haiti.
Jeffrey Taekman, MD, is a Professor of Anesthesiology at Duke and the Assistant Dean for Educational Technology within the School of Medicine. Dr. Taekman directs the Duke University Human Simulation and Patient Safety Center. Dr. Taekman is a recipient of the International Anesthesia Research Society Teaching Recognition Award for Innovation in Education and recently served as lead judge in the Institute of Medicine/Society for Simulation in Healthcare Serious Games and Virtual Environments Showcase at the Global Forum on Innovation in Health Professional Education.
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