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Fayyaz J, Jaeger M, Takundwa P, Iqbal AU, Khatri A, Ali S, Mukhtar S, Saleem SG, Whitfill T, Ali I, Duff JP, Kardong‐Edgren S(S, Gross IT. Exploring cultural sensitivity during distance simulations in pediatric emergency medicine. AEM EDUCATION AND TRAINING 2023; 7:e10908. [PMID: 37997591 PMCID: PMC10664395 DOI: 10.1002/aet2.10908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 11/25/2023]
Abstract
Background Cultural sensitivity (CS) training is vital to pediatric emergency medicine (PEM) curricula. This study aimed to explore CS in Yale PEM fellows and emergency medicine (EM) residents at Indus Hospital and Health Network (IHHN) in Pakistan through distance simulation activities. Methods This mixed-methods analysis of an educational intervention was conducted at Yale University in collaboration with IHHN. We approached seven U.S. PEM fellows and 22 Pakistani EM residents. We performed a baseline CS assessment using the Clinical Cultural Competency Questionnaire (CCCQ). Afterward, the U.S. PEM fellows facilitated the Pakistani EM residents through six distance simulation sessions. Qualitative data were collected through online focus groups. The CCCQ was analyzed using descriptive statistics, and content analysis was used to analyze the data from the focus groups. Results Seven U.S. PEM fellows and 18 of 22 Pakistani EM residents responded to the CCCQ at the beginning of the module. The mean (±SD) CCCQ domain scores for the U.S. PEM fellows versus the Pakistani EM residents were 2.56 (±0.37) versus 2.87 (±0.72) for knowledge, 3.02 (±0.41) versus 3.33 (±0.71) for skill, 2.86 (±0.32) versus 3.17 (±0.73) for encounter/situation, and 3.80 (±0.30) versus 3.47 (±0.47) for attitude (each out of 5 points). Our qualitative data analysis showed that intercultural interactions were valuable. There is a common language of medicine among the U.S. PEM fellows and Pakistani EM residents. The data also highlighted a power distance between the facilitators and learners, as the United States was seen as the standard of "how to practice PEM." The challenges identified were time differences, cultural practices such as prayer times, the internet, and technology. The use of local language during debriefing was perceived to enhance engagement. Conclusion The distance simulation involving U.S. PEM fellows and Pakistani EM residents was an effective approach in assessing various aspects of intercultural education, such as language barriers, technical challenges, and religious considerations.
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Affiliation(s)
- Jabeen Fayyaz
- University of TorontoTorontoOntarioCanada
- The Hospital for Sick ChildrenTorontoOntarioCanada
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Department of Pediatrics, Division of Pediatric Critical Care (PICU), Faculty of Medicine & DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Margret Jaeger
- Research DepartmentEducation Centre of Social Fund ViennaViennaAustria
| | - Prisca Takundwa
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Ammarah U. Iqbal
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Adeel Khatri
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | - Saima Ali
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | - Sama Mukhtar
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | | | - Travis Whitfill
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Inayat Ali
- Department of Public Health and Allied Sciences, Department of AnthropologyFatima Jinnah Women's UniversityRawalpindiPakistan
| | - Jonathan P. Duff
- Department of Pediatrics, Division of Pediatric Critical Care (PICU), Faculty of Medicine & DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Suzan (Suzie) Kardong‐Edgren
- Health Professions Education Program, Center for Interprofessional Studies and InnovationMGH Institute of Health ProfessionBostonMassachusettsUSA
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Mossenson AI, Ocholi D, Gower S, Livingston PL. Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study. Anesth Analg 2023; 137:551-558. [PMID: 37043403 DOI: 10.1213/ane.0000000000006468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces. METHODS This qualitative study used focus group interviews with 24 VAST FC graduates (from 12 low- and middle-income and 12 high-income countries) to explore how they had applied new learning in the workplace. Focus groups were conducted by videoconferencing with data transcribed verbatim. Data were analyzed using inductive thematic analysis. RESULTS Enabler themes for knowledge and skill translation following facilitator training were (1) the structured debriefing framework, (2) the ability to create a supportive learning environment, and (3) being able to meaningfully discuss nontechnical skills. Two subthemes within the debriefing framework were (1.1) knowledge of conversational techniques and (1.2) having relevance to clinical debriefing. Barrier themes limiting skill application were (1) added time and effort required for comprehensive debriefing, (2) unsupportive workplaces, and (3) lack of opportunities for mentorship and practice postcourse. CONCLUSIONS Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.
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Affiliation(s)
- Adam I Mossenson
- From the SJOG Midland Public and Private Hospitals, Perth, Western AustraliaAustralia
- Curtin University, Perth, Western Australia, Australia
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deborah Ocholi
- Faculty of Medicine, Dalhousie University, HalifaxNova Scotia, Canada
| | - Shelley Gower
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Patricia L Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Chen YC, Issenberg SB, Chiu YJ, Chen HW, Issenberg Z, Kang YN, Lin CW, Wu JC. Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events. MEDICAL TEACHER 2023; 45:368-374. [PMID: 36288746 DOI: 10.1080/0142159x.2022.2137394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues. METHODS A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey. RESULTS During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event. CONCLUSIONS Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].
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Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Wen Chen
- NP, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | | | - Yi-No Kang
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Lin
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
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Hosseini M, Heydari A, Reihani H, Kareshki H. Development and psychometric properties of teamwork scale in resuscitation: A sequential exploratory mixed-method study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:10. [PMID: 37034876 PMCID: PMC10079185 DOI: 10.4103/jehp.jehp_139_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/12/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Non-technical skills as a complement to technical skills have become increasingly important in cardio-pulmonary resuscitation, and teamwork is one of the most prominent of these skills. Because of the limited number of tools introduced and validated for measuring teamwork in resuscitation, this study was conducted to develop and evaluate the psychometric properties of the Teamwork Scale in Resuscitation (TSR). MATERIALS AND METHODS This study was a sequential exploratory mixed-method study and was conducted between March 2020 and April 2021 and in two phases. In the first phase (qualitative), semi-structured interviews were performed with resuscitation team members who were selected using a purposeful sampling method with maximum variation in terms of experience, level of education, age, and gender. Using directed qualitative content analysis, the data were analyzed and the primary item pool was developed. In the second phase (quantitative), assessing face, content, and construct validity as well as reliability via the internal consistency and stability, the psychometric properties of the instrument are evaluated. RESULTS The initial tool consisted of 54 items; after assessing the face validity, ten items were removed during content validity, and the final tool consisted of 44 items and three main categories including the essential prerequisites for resuscitation, leadership, and teamwork, which was scored based on a 5-point Likert scale from strongly disagree to strongly agree. The convergent validity and concurrent validity of the tool were confirmed. The reliability of the instrument was also confirmed using Cronbach's alpha test and re-test and the intra-class correlation coefficient (ICC) between raters. CONCLUSION The validity and reliability of TSR for measuring teamwork in resuscitation in a simulated environment are approved. Further studies are suggested for different contexts of resuscitation and with trained raters to evaluate its use in real resuscitation situations.
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Affiliation(s)
- Mohammad Hosseini
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kareshki
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Iran
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Lutala P, Muula A. Brief behaviour change counselling in non-communicable diseases in Mangochi, Southern Malawi: a hypothetical acceptability study. Pilot Feasibility Stud 2022; 8:69. [PMID: 35331326 PMCID: PMC8944110 DOI: 10.1186/s40814-022-01032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Brief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) among health providers, policy-makers and patients living with noncommunicable diseases (NCDs) in the Mangochi district located in Malawi. METHODS An exploratory qualitative cross-sectional study used purposive sampling to select 44 respondents. We conducted group discussions with five focus groups that included patients. We also carried out nine key-informant interviews with healthcare providers and policy-makers. Data were managed and organized with Atlas.ti. cloud and analysed using the thematic framework approach. FINDINGS Several themes, categories, and their subcategories emerged from the interviews. Participants perceived the introduction and delivery of BBCC + 5As + GS in Mangochi as smooth. However, they predicted a few challenges such as time and space to conduct the intervention, cultural bottlenecks caused by low education level, age differences between healthcare providers and patients, low provider- to- patient ratio and high provider turnover. For this method to be adopted, a simplified format is deemed necessary to improve effectiveness with patients. This technique can only be sustained if training opportunities are provided and if positive testimonies are given by beneficiaries. Incorporation of a continuous quality improvement cycle targeting challenges must be part of the intervention. Participants perceived that BBCC will contribute to developing the listening ability of healthcare providers. This would help in providing personalized and cost-effective care relevant to Mangochi. The participants also perceived that BBCC + 5As + GS will be affordable, credible and useful. CONCLUSION We found a high acceptability rate of BBCC among stakeholders in NCDs clinics in Mangochi. There are a number of areas where BBCC + 5As + GS could be improved to increase the acceptability. Accordingly, a study of feasibility and preliminary efficacy is warranted to determine other prerequisites for the implementation of a large-scale trial using this BBCC+ 5 As + GS, and to fully understand the implementation requirements of a full trial in Mangochi.
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Affiliation(s)
- Prosper Lutala
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi. .,NCDs-Brite Consortium, College of Medicine, University of Malawi, Zomba, Malawi. .,Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM), Zomba, Malawi. .,College of Medicine Mangochi Campus, P.O. Box 431, Mangochi, Malawi.
| | - Adamson Muula
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi.,Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM), Zomba, Malawi
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Chen YC, Issenberg SB, Issenberg Z, Chen HW, Kang YN, Wu JC. Factors associated with medical students speaking-up about medical errors: A cross-sectional study. MEDICAL TEACHER 2022; 44:38-44. [PMID: 34477475 DOI: 10.1080/0142159x.2021.1959904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Training medical students to speak up when they witness a potential error is an important competency for patient safety, but details regarding the barriers that prevent medical students from effectively communicating are lacking. Therefore, this study aimed at exploring the factors affecting medical students' willingness to speak up for patient safety when a medical error was observed. METHODS This is a cross-sectional study at a medical university in Taiwan, and 151 medical students in clinical clerkship completed a survey including demographic characteristics, conflict of interests/social relationship, personal capability, and personality and characteristics of senior staff domains. Data were analyzed using t-test. RESULTS Three of five items in the conflict of interests/social relationship domain showed statistically significant importance, including 'I am afraid of being punished' (Mean difference, MD = 0.37; p < 0.01), 'I do not want to break unspoken rules' (MD = 0.55; p < 0.01), and 'I do not want to have bad team relationship' (MD = 0.58; p < 0.01). Two items (perception of knowledge/understanding and communication skills) in the personal capability domain were significantly important to speaking up. Six of 10 items in personality and characteristics of senior staff domain were rated significantly important in deciding to speak up. The top three factors of them were senior personnel with 'Grumpy' personality (MD = 1.20; p < 0.01), 'hierarchy gap' (MD = 1.12; p < 0.01), and senior personnel with 'Stubborn' personality (MD = 1.06; p < 0.01). CONCLUSION Our findings demonstrated medical students' perspectives on barriers to speaking up in the event of medical error. Some factors related to characteristics of senior staff could compromise medical students' ability to speak up in the event of medical error. These results might be important for medical educators in designing personalized educational activities related to medical students' ability to speak up for patient safety.
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Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Medicine and Michael S. Gordon Chair of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Nursing and Health in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Continuing Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hui-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yi-No Kang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
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Bettinger K, Mafuta E, Mackay A, Bose C, Myklebust H, Haug I, Ishoso D, Patterson J. Improving Newborn Resuscitation by Making Every Birth a Learning Event. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121194. [PMID: 34943390 PMCID: PMC8700033 DOI: 10.3390/children8121194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.
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Affiliation(s)
- Kourtney Bettinger
- Department of Pediatrics, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 4004, Kansas City, KS 66103, USA
| | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Amy Mackay
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Helge Myklebust
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Ingunn Haug
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Jackie Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
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Abstract
SUMMARY STATEMENT Culture influences how we communicate, teach, and learn. Debriefings are laden with cultural influences. Without attention to cultural considerations, accepted debriefing techniques might not reach the desired outcome and, in certain cultures, may even harm teacher-learner relationships. We explore cultural considerations in healthcare simulation debriefing and offer guidance for debriefers to gain awareness of potential cultural biases.
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Affiliation(s)
- Janice C Palaganas
- From the MGH Institute of Health Professions (J.C.P.); Harvard Medical School, Boston, MA (J.C.P.); Prince of Wales Hospital, Sha Tin, Hong Kong (A.C.); and Hamad Medical Corporation, Doha, Qatar (K.L.)
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Mossenson AI, Bailey JG, Whynot S, Livingston P. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings. Anesth Analg 2021; 133:215-225. [PMID: 34127590 DOI: 10.1213/ane.0000000000005584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development. METHODS This qualitative study used in-depth interviews to explore VAST facilitators' perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature. RESULTS Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice. CONCLUSIONS The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.
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Affiliation(s)
- Adam I Mossenson
- From the Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Dalhousie University, Curtin University, Perth, Western Australia
| | - Jonathan G Bailey
- Department of Anesthesia, Pain Management, and Perioperative Medicine
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Palaganas JC, Charnetski M, Dowell S, Chan AKM, Leighton K. Cultural considerations in debriefing: a systematic review of the literature. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:605-610. [DOI: 10.1136/bmjstel-2020-000857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/10/2021] [Indexed: 11/03/2022]
Abstract
BackgroundConversations are influenced by cultural perceptions, beliefs and values. Debriefing is a learning conversation. Without cross-cultural engagement or culturally relevant teaching, learning may be compromised and may result in an outcome opposite of that intended.ObjectiveThis systematic review explores cultural considerations in healthcare simulation debriefing. We sought to explore findings that could help debriefers create culturally responsive and inclusive debriefings.Study selectionStudies were included if they were peer-reviewed articles in any language and focused on healthcare simulation debriefing and global cultural considerations. Research study methods included qualitative, quantitative or both. The review included any health-related profession and level of learner.FindingsThree studies met the criteria. The purposes of the three studies were significantly different and did not directly study cultural considerations in debriefing.ConclusionsThe learner–educator relationship is at risk and learning may be negatively impacted without addressing cultural awareness. More studies are needed to fully describe the effect of culture on successful debriefing.
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Hai-Ping Y, Wei-Ying Z, You-Qing P, Yun-Ying H, Chi C, Yang-Yang L, Li-Li H. Emergency medical staff's perceptions on cultural value difference-based teamwork issues: A phenomenological study in China. J Nurs Manag 2020; 28:24-34. [PMID: 31454450 DOI: 10.1111/jonm.12854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/12/2023]
Abstract
AIM To explore how different cultural values are connected to teamwork between doctors and nurses in emergency departments (EDs) in China. BACKGROUND China is a multicultural society, which leads to different cultural values being represented within its population. Doctors and nurses from different cultural backgrounds bring their own cultural values to their workplaces that influence teamwork. EDs are medical treatment facilities designed to provide episodic care to patients suffering from acute injuries and illnesses. Doctors and nurses in EDs should not only be highly skilled but also be able to work as a team. Studies have shown that different cultural values are often the cause of poor teamwork. However, there has been little focus on this phenomenon in the literature on ED. Therefore, this study aimed to identify how cultural values are connected to teamwork in EDs. DESIGN Phenomenological study. METHODS In-depth interviews were conducted with 10 doctors and 10 nurses in EDs from September to December 2018 in three large general hospitals in Shanghai. RESULTS Four major themes emerged from the data: leadership, communication, mutual support and staffing. Twelve sub-themes were identified (a) hierarchy between superiors and subordinates; (b) doctors as superiors; (c) Northerners are more powerful; (d) emphasizing etiquette; (e) traditionally feminine traits; (f) face-to-face communication; (g) collectivism; (h) being open-minded; (i) tense doctor-patient relationships; (j) clique culture; (k) high pressure; and (l) home culture. CONCLUSIONS Teamwork between doctors and nurses in EDs is influenced by different cultural values. Future research should be carried out to identify which factors are essential to improving teamwork among doctors and nurses in hospital EDs. IMPLICATIONS FOR NURSING MANAGEMENT It is important to develop strategies to foster teamwork between doctors and nurses with different cultural values.
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Affiliation(s)
- Yu Hai-Ping
- Department of Nursing, Tongji University School of Medicine, Shanghai, China
| | - Zhang Wei-Ying
- Department of Nursing, Tongji University School of Medicine, Shanghai, China
| | - Peng You-Qing
- Department of Nursing, Tongji University School of Medicine, Shanghai, China
| | - Hung Yun-Ying
- International & Overseas Affairs, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chen Chi
- Teaching and Training Office, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li Yang-Yang
- Emergency Department, Tongji University School of Medicine, Shanghai, China
| | - Hou Li-Li
- Department of Nursing, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Raney JH, Medvedev MM, Cohen SR, Spindler H, Ghosh R, Christmas A, Das A, Gore A, Mahapatra T, Walker D. Training and evaluating simulation debriefers in low-resource settings: lessons learned from Bihar, India. BMC MEDICAL EDUCATION 2020; 20:9. [PMID: 31914989 PMCID: PMC6951007 DOI: 10.1186/s12909-019-1906-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/13/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND To develop effective and sustainable simulation training programs in low-resource settings, it is critical that facilitators are thoroughly trained in debriefing, a critical component of simulation learning. However, large knowledge gaps exist regarding the best way to train and evaluate debrief facilitators in low-resource settings. METHODS Using a mixed methods approach, this study explored the feasibility of evaluating the debriefing skills of nurse mentors in Bihar, India. Videos of obstetric and neonatal post-simulation debriefs were assessed using two known tools: the Center for Advanced Pediatric and Perinatal Education (CAPE) tool and Debriefing Assessment for Simulation in Healthcare (DASH). Video data was used to evaluate interrater reliability and changes in debriefing performance over time. Additionally, twenty semi-structured interviews with nurse mentors explored perceived barriers and enablers of debriefing in Bihar. RESULTS A total of 73 debriefing videos, averaging 18 min each, were analyzed by two raters. The CAPE tool demonstrated higher interrater reliability than the DASH; 13 of 16 CAPE indicators and two of six DASH indicators were judged reliable (ICC > 0.6 or kappa > 0.40). All indicators remained stable or improved over time. The number of 'instructors questions,' the amount of 'trainee responses,' and the ability to 'organize the debrief' improved significantly over time (p < 0.01, p < 0.01, p = 0.04). Barriers included fear of making mistakes, time constraints, and technical challenges. Enablers included creating a safe learning environment, using contextually appropriate debriefing strategies, and team building. Overall, nurse mentors believed that debriefing was a vital aspect of simulation-based training. CONCLUSION Simulation debriefing and evaluation was feasible among nurse mentors in Bihar. Results demonstrated that the CAPE demonstrated higher interrater reliability than the DASH and that nurse mentors were able to maintain or improve their debriefing skills overtime. Further, debriefing was considered to be critical to the success of the simulation training. However, fear of making mistakes and logistical challenges must be addressed to maximize learning. Teamwork, adaptability, and building a safe learning environment enhanced the quality enhanced the quality of simulation-based training, which could ultimately help to improve maternal and neonatal health outcomes in Bihar.
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Affiliation(s)
- Julia H. Raney
- Department of Pediatrics, Stanford University, 725 Welch Rd, MC: 5906, Palo Alto, CA 94304 USA
| | - Melissa M. Medvedev
- Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Susanna R. Cohen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112 USA
| | - Hilary Spindler
- Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA 94158 USA
| | - Rakesh Ghosh
- Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA 94158 USA
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Aritra Das
- Care India Solutions for Sustainable Development, 14 Patliputra Colony, Patna, Bihar 800013 India
| | - Aboli Gore
- Care India Solutions for Sustainable Development, 14 Patliputra Colony, Patna, Bihar 800013 India
| | - Tanmay Mahapatra
- Care India Solutions for Sustainable Development, 14 Patliputra Colony, Patna, Bihar 800013 India
| | - Dilys Walker
- Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA 94158 USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
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French AJ. Simulation and Modeling Applications in Global Health Security. ADVANCED SCIENCES AND TECHNOLOGIES FOR SECURITY APPLICATIONS 2020. [PMCID: PMC7123972 DOI: 10.1007/978-3-030-23491-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Global health security (GHS) is dependent upon having an adequate and prepared health security workforce. There are currently numerous challenges in establishing and maintaining a health security workforce. The frequency and magnitude of disasters have increased significantly over the past 30 years. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging GHS threats. Developing and maintaining GHS -specific skills in the healthcare workforce is a tremendous logistical challenge. Innovative education technologies, including simulation and digital learning, can be leveraged to achieve preparedness for GHS threats. This chapter focuses on the application of modeling and simulation to support Global Health Security planning, preparedness and operations.
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Turkot O, Banks MC, Lee SW, Dodson A, Duarte S, Kaino M, Nelson-Williams H, Toy S, Sampson J. A Review of Anesthesia Simulation in Low-Income Countries. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00305-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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