Immersive Simulation Education: A Novel Approach to Pandemic Preparedness and Response

Artificial intelligence empowering public health education: prospects and challenges

Artificial Intelligence (AI) is revolutionizing public health education through its capacity for intricate analysis of large-scale health datasets and the tailored dissemination of health-related information and interventions. This article conducts a profound exploration into the integration of AI within public health, accentuating its scientific foundations, prospective progress, and practical application scenarios. It underscores the transformative potential of AI in crafting individualized educational programs, developing sophisticated behavioral models, and informing the creation of health policies. The manuscript strives to thoroughly evaluate the extant landscape of AI applications in public health, scrutinizing critical challenges such as the propensity for data bias and the imperative of safeguarding privacy. By dissecting these issues, the article contributes to the conversation on how AI can be harnessed responsibly and effectively, ensuring that its application in public health education is both ethically grounded and equitable. The paper's significance is multifold: it aims to provide a blueprint for policy formulation, offer actionable insights for public health authorities, and catalyze the progression of health interventions toward increasingly sophisticated and precise approaches. Ultimately, this research anticipates fostering an environment where AI not only augments public health education but also does so with a steadfast commitment to the principles of justice and inclusivity, thereby elevating the standard and reach of health education initiatives globally.

Training-of-trainers program for community health workers involved in an innovative and community-based intervention against malaria among goldminers in the Guiana shield: a quality and effectiveness evaluation

Introduction

An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention consists of the distribution of malaria self-management kits to goldminers and the presumptive treatment for individuals at risk of carrying Plasmodium vivax hypnozoites. The intervention is possible owing to community health workers (CHWs) who are previously trained to master all intervention procedures, including health education activities and goldmining training. This study aimed to evaluate the training program provided to CHWs in terms of quality and effectiveness.

Methods

A training-of-trainers program for CHWs has been developed based on the CDC framework. A mixed-method case study was implemented in two steps between February and March 2023. The evaluation was based on a knowledge survey, satisfaction test, observations, and semi-structured interviews. Quantitative and qualitative data were analyzed and triangulated.

Results

A total of 20 CHWs participated in the training and the first-step evaluation. For the second step, four semi-structured interviews were conducted. The Qualitative data showed that group dynamics and adaptations were central elements of a high-quality training program. Quantitative analysis found that CHWs' satisfaction was elevated (> 4/5 overall), especially regarding format and learning results. Improvements in knowledge level demonstrated good effectiveness (pre-training vs. post-training, p < 0.05). Nevertheless, some difficulties persisted regarding tasks of the intervention procedure, such as informed consent and smartphone application procedures (with an inaccuracy rate of 29.2% and 16.7%, respectively). Further on-the-job training permitted to address these issues. The project team's previous experience and the Guiana Shield countries' commitment to the WHO-E-2025-initiative were identified as levers for the quality of the training, while the complexity of the project context was a challenge.

Discussion

High-quality, effective, and appropriate training programs are required for effective and sustainable interventions involving CHW profiles. Training design is a crucial point to address to accomplish quality and effectiveness. The training-of-trainers model has been shown to allow a high level of satisfaction, good learning results, and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs' motivation. Training evaluation permits standardizing methods and facilitates transferability.

Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

Evaluating simulations as preparation for health crises like CoVID-19: Insights on incorporating simulation exercises for effective response

Today's health emergencies are increasingly complex due to factors such as globalization, urbanization and increased connectivity where people, goods and potential vectors of disease are constantly on the move. These factors amplify the threats to our health from infectious hazards, natural disasters, armed conflicts and other emergencies wherever they may occur. The current CoVID-19 pandemic has provided a clear demonstration of the fact that our ability to detect and predict the initial emergence of a novel human pathogen (for example, the spill-over of a virus from its animal reservoir to a human host), and our capacity to forecast the spread and transmission of the pathogen in human society remains limited. Improving ways in which we prepare will enable a more rapid and effective response and enable proactive preparations (including exercising) to respond to any novel emerging infectious disease outbreaks. This study aims to explore the current state of pandemic preparedness exercising and provides an assessment of a number of case study exercises for health hazards against the key components of the WHO's Exercises for Pandemic Preparedness Plans (EPPP) framework in order to gauge their usefulness in preparation for pandemics. The paper also examines past crises involving large-scale epidemics and pandemics and whether simulations took place to test health security capacities either in advance of the crisis based on risk assessments, strategy and plans or after the crisis in order to be better prepared should a similar scenario arise in the future. Exercises for animal and human diseases have been included to provide a "one health" perspective [1,2]. This article then goes on to examine approaches to simulation exercises relevant to prepare for a health crisis involving a novel emergent pathogen like CoVID-19. This article demonstrates that while simulations are useful as part of a preparedness strategy, the key is to ensure that lessons from these simulations are learned and the associated changes made as soon as possible following any simulation in order to ensure that simulations are effective in bringing about changes in practice that will improve pandemic preparedness. Furthermore, Artificial Intelligence (AI) technologies could also be applied in preparing communities for outbreak detection, surveillance and containment, and be a useful tool for providing immersive environments for simulation exercises for pandemic preparedness and associated interventions which may be particularly useful at the strategic level. This article contributes to the limited literature in pandemic preparedness simulation exercising to deal with novel health crises, like CoVID-19. The analysis has also identified potential areas for further research or work on pandemic preparedness exercising.

Primary care nurses' preparedness for COVID-19 in the Western Cape province, South Africa

INTRODUCTION

The novel coronavirus 2019 or COVID-19 pandemic has brought about a global public health crisis. Primary care (PC) nurses render first line care, or refer for more specialised services.

AIM

To investigate the preparedness of PC nurses for COVID-19 in the Western Cape.

SETTING

The Western Cape province of South Africa.

METHODS

We administered an online survey, with closed and open-ended questions, to 83 Stellenbosch University postgraduate PC nursing students and alumni working in the Western Cape, between 03 July and 01 September 2020.

RESULTS

The results indicated that 43.3% of participants were confident about the infection, prevention, and control (IPC) training they received and 56.7% felt prepared to provide direct care to suspected cases of COVID-19. Primary care nurses were more comfortable to triage (78.3%) than to manage persons with COVID-19 (42.2%), indicating that they may not be functioning to the full capacity of their education and training. Adequate infrastructure was reported by less than a third of the participants (30.1%) and 59.1% reported that personal protective equipment (PPE) was always available. Primary care nurses needed support in coping with stress (57.8%) although few (14.5%) reported access to mental health services.

CONCLUSION

Primary care nurses were not prepared optimally for the COVID-19 pandemic. Challenges included adequate training, infrastructure, the availability of personal protective equipment, COVID-19 testing of health care workers and management support. Primary care nurses need comprehensive support to manage stress and anxiety.

The Effectiveness of Functional Exercises for Teaching Method Disaster Medicine to Medical Students

Introduction

Functional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise.

Objective

The study objective is to investigate whether functional exercise is effective for teaching disaster medicine.

Methods

Students who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise.

Results

Ninety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students’ willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise.

Conclusion

Disaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.

Implementation and evaluation of a pandemic simulation exercise among undergraduate public health and nursing students: A mixed-methods study

BACKGROUND

In addition to overwhelming the healthcare system, pandemics have enormous societal and economic costs. To better train future healthcare professionals and develop collaborations across healthcare disciplines, pandemic simulations have been incorporated into undergraduate healthcare professional curricula.

OBJECTIVES

The purpose of this study was to assess the usefulness of a pandemic simulation in preparing the future healthcare professionals during large-scale pandemic disasters.

DESIGN

This was a mixed-methods, cross-sectional study.

SETTING

The study was conducted at a 4-year public university in rural Texas.

METHODS

The students (n = 89) participated in a simulation exercise that mirrored a real influenza pandemic that facilitated interactions among various first responders. Participants completed pre- and post-tests of knowledge survey questions pertaining to areas of situational awareness, communication effectiveness and public health knowledge, and the 27-item Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale.

RESULTS

The majority (76%) of the participants were between the ages of 18 to 24, Caucasians (74.2%) and female (87.6%). The results of the paired t-test showed increased situational awareness [t = 7.17₍₇₆₎, p < 0.001], effective communication [t = 7.130₍₇₅₎, p < 0.001], and public health knowledge [t = 8.77 ₍₇₄₎, p < 0.001] following the pandemic simulation.

CONCLUSION

Significant improvement in situational awareness, effective communication, and public health knowledge was demonstrated by the undergraduate public health and nursing students in handling disasters through the simulation exercise. The study results demonstrated value in incorporating simulation as an effective teaching strategy in preparing future healthcare professionals.

Implementation of Simulation Training During the COVID-19 Pandemic: A New York Hospital Experience

SUMMARY STATEMENT

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Obstetric simulation for a pandemic

OBJECTIVE

In the middle of the COVID-19 pandemic, guidelines and recommendations are rapidly evolving. Providers strive to provide safe high-quality care for their patients in the already high-risk specialty of Obstetrics while also considering the risk that this virus adds to their patients and themselves. From other pandemics, evidence exists that simulation is the most effective way to prepare teams, build understanding and confidence, and increase patient and provider safety.

FINDING

Practicing in-situ multidisciplinary simulations in the hospital setting has illustrated key opportunities for improvement that should be considered when caring for a patient with possible COVID-19.

CONCLUSION

In the current COVID-19 pandemic, simulating obstetrical patient care from presentation to the hospital triage through postpartum care can prepare teams for even the most complicated patients while increasing their ability to protect themselves and their patients.

Educating, training, and exercising for infectious disease control with emphasis on cross-border settings: an integrative review

INTRODUCTION

Points of entry and other border regions educate, train, and exercise (ETEs) their staff to improve preparedness and response to cross-border health threats. However, no conclusive knowledge of these ETEs' effectiveness exists. This study aimed to review the literature on ETEs in infectious disease control concerning their methods and effect, with an emphasis on cross-border settings and methods that enlarge ETEs' reach.

METHODOLOGY

We systematically searched for studies in the databases Embase, Medline, Web of Science, PsycInfo, ERIC, and Cinahl. After successively screening titles and abstracts, full-texts, and citations, 62 studies were included using in- and exclusion criteria. Data were extracted using a data-extraction form. Quality assessment was performed. We developed a theoretical framework based on which we analyzed the ETE context (target group, recruitment, autonomy, training needs), input (topic, trainers, development and quality of materials), process (design, duration, interval, goals), evaluation (pre-, post- follow-up tests), and outcome (reaction, learning, behavior, and system).

RESULTS

We found a limited number of published evaluations of ETEs in general (n = 62) and of cross-border settings (n = 5) in particular. The quality assessment resulted in seven ETE methodologies and 23 evaluations with a 'good' score. Both general studies and those in a cross-border setting contain a low-moderate detail level on context, input, and process. The evaluations were performed on reaction (n = 45), learning (n = 45), behavior (n = 9) and system (n = 4), mainly using pre- and post-tests (n = 22). Online learning methods have a high potential in enlarging the reach and are effective, particularly in combination with offline training. Training-of-trainer approaches are effective for learning; new ETEs were developed by 20-44% of participants until six months after the initial training.

CONCLUSION

Our study reveals a limited number of publications on ETEs in infectious disease control. Studies provide few details on methodology, and use mainly short-term evaluations and low level outcomes. We call for more extensive, higher-level evaluation standards of ETEs, and an easy and sustainable way to exchange evaluations within the workforce of infectious disease control in cross-border settings. The theoretical framework developed in this study could guide future development and evaluation of ETEs in infectious disease control.

Reality Check: Preparing Nursing Students to Respond to Ebola and Other Infectious Diseases

Escalating uncertainty regarding the international impact of Ebola virus disease and other infectious diseases prompted educators to develop interactive, multidisciplinary training for senior-level baccalaureate nursing students. A three-hour clinical learning session was scheduled within the curriculum. Nurse faculty utilized 11 activities to increase students' awareness and understanding of the potential and actual impact of Ebola virus disease and other infectious diseases. Feedback reflected a positive student experience highlighting several key areas related to increased knowledge and confidence. This session highlighted the importance of adjusting focus and priorities within curricula to meet core baccalaureate essentials and address current public health needs.

Disease outbreaks as vehicles for exploring 'engaged citizen' themes through a course on the history of infectious diseases

Infectious diseases are potential catalysts for exploring 'engaged citizen' or socioscientific themes given their interwoven economic, political, scientific and social dimensions. This article describes how an undergraduate course on the history of infectious diseases was modified to explore the impact of two 'engaged citizen' themes (poverty and technology), and to consider the ramifications of those themes on past, present and future infectious disease outbreaks. Four outbreaks were used as the foundation for the course: plague (1350s), puerperal fever (1840s), cholera (1850s) and syphilis (1930s). The first part of the article describes the general course structure and the role of university-wide 'engaged citizen' themes in its semester-specific construction. The second part of the article demonstrates how poverty and technology 'threads' were explored in each of the four historical contexts, and subsequently how they were considered in current and future contexts; appendices with lesson suggestions are provided. The third and final part of the article discusses how this specific model might be more broadly applied to other microbiology instructional contexts.

Ebola Emergency Preparedness: Simulation Training for Frontline Health Care Professionals

INTRODUCTION

At Brigham and Women's Hospital, we identified the need for a comprehensive training program designed to prepare frontline staff to safely manage a patient with Ebola viral disease (EVD). The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD.

METHODS

We delivered a 4-hour experiential training program to frontline health care professionals who would be expected to care for a patient with EVD. The program occurred in a simulation center with multiple flexible spaces and consisted of demonstration, multiple skills practice sessions, and a patient simulation case. We analyzed completed pre- and posttraining questionnaires. The questionnaire assessed their subjective level of confidence in three key areas: donning and doffing PPE, performing clinical skills while wearing PPE, and management of a contamination breach.

RESULTS

This program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. Our intervention significantly increased the confidence of participants on each primary objective (p = .001 for all three stations).

DISCUSSION

This interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Our intent is that the skills taught in this training program would also be transferable to management of other infectious diseases in the clinical setting.