Dubrowski 1 SSE

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  • 1. Teaching the Trainers in Simulation Based Education: Barriers and Solutions Dubrowski A., MiliardDerbew, Byrne N., Pittini R., Satterthwaite L., and Tajirian T. 
     Roger Kneebone
    Alison Barnet
    Fernando Bello
     
    Supported by DelPHE
  • 2. Ethiopia
    Maternal 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.
  • 3. Ethiopia
    Maternal 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.
  • 4. 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.
  • 5. 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.
  • 6. simulation
    Replication of a task or an event for the purpose of training or evaluation
  • 7. November 2006
    Medical Education, 2009
  • 8. t=2.81, p=.012
    t=3.42, p=.003
    25
    14
    20
    12
    10
    15
    8
    Checklists
    GRS
    10
    6
    Post-test
    4
    Pre-test
    5
    2
    0
    0
  • 9. Pre-training
    Post-training
  • 10. 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.
  • 11. Three primary objectives during this meeting were:
    To identify current use of simulation resources in the Surgical Simulation Laboratory (SSL, The Black Lion hospital, Faculty of Medicine, Addis Ababa University),
    to identify potential areas for faculty development (Train the Trainer) programs to enable optimal use of the SSL, and
    to develop a plan for Train the Trainer program and its implementation.
  • 12. 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.
  • 13. 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.
  • 14. 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.
  • 15. 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.
  • 16. 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. MaisamFazel).
  • 17. 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).
  • 18. Planned activities:
    Year 3: “Sustainability”
    Evaluation of the program.
    Exporting the program to other schools in Ethiopia and Sub-Saharan Africa.
  • 19. 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.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27. Summary:
    The course was graduated by 12 clinicians and 2 administrators.
    UTAASC was formed.
  • 28. Inactivity
    External factors
    Lack of follow up from us
    Internal factors
    Top down rather than bottom up process
  • 29. Next steps (November 2009):
    Distribution of a source book
    Development of a guide book
    Environmental re-scan and stakeholder re-analysis
    Assign specific roles
  • 30. Next steps (November 2009):
    Distribution of a source book
  • 31.
  • 32.
  • 33. 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
  • 34. Next steps (November 2009):
    Environmental re-scan and stakeholder re-analysis
  • 35.
  • 36. Infrastructure:
    Skill lab
    inanimate and animal models
    instructional videos
    Faculty:
    Interest of the faculty and leadership in the lab
    Strong support from department members to have the curriculum designed
    Strong interest by faculty and department head
    Interdepartmental cooperation
    Students:
    Interested students
    Expanding post graduate program
  • 37. Infrastructure:
    Financial constraint/Budget
    Single and small skills lab
    Limited resources and times
    Accessibility to all staff 24/7
     
    Faculty and staff:
    Management
    Limited and untrained staff
    Less advertised even within faculty
    Poor linkage
    Incentives for faculty members
     
    Program:
    Absence of well-structured program
    Under-developed curriculum
    Infrastructure:
    Skill lab
    inanimate and animal models
    instructional videos
    Faculty:
    Interest of the faculty and leadership in the lab
    Dedicated staff
    Strong support from department members to have the curriculum designed
    Strong interest by faculty and department head
    Interdepartmental cooperation
    Young surgeons who have good energy
    Students:
    Interested students
    Expanding post graduate program
  • 38. Infrastructure:
    Skill lab
    inanimate and animal models
    instructional videos
    Faculty:
    Interest of the faculty and leadership in the lab
    Dedicated staff
    Strong support from department members to have the curriculum designed
    Strong interest by faculty and department head
    Interdepartmental cooperation
    Young surgeons who have good energy
    Students:
    Interested students
    Expanding post graduate program
    Infrastructure:
    Financial constraint/Budget
    Single and small skills lab
    Limited resources
    Accessibility to all staff 24/7
    Lack of time
     
    Faculty and staff:
    Management, committed support staff
    Limited and untrained staff
    Less advertised even within faculty
    Administration
    Poor linkage (duplication)
    Incentives for faculty members
     
    Program:
    Absence of well-structured program
    Less developed curriculum
    Collaboration with other skills labs
    Partner with external institution like U of T, Imperial Collage
    Favorable policy and commitment
    Huge inter/intra networking
    Expanding and diversity of graduate studies
    Support from grants [e.g., DelPHE]
    Support from CNIS
  • 39. Infrastructure:
    Skill lab
    inanimate and animal models
    instructional videos
    Faculty:
    Interest of the faculty and leadership in the lab
    Dedicated staff
    Strong support from department members to have the curriculum designed
    Strong interest by faculty and department head
    Interdepartmental cooperation
    Young surgeons who have good energy
    Students:
    Interested students
    Expanding post graduate program
    Infrastructure:
    Financial constraint/Budget
    Single and small skills lab
    Limited resources
    Accessibility to all staff 24/7
    Lack of time
     
    Faculty and staff:
    Management, committed support staff
    Limited and untrained staff
    Less advertised even within faculty
    Administration
    Poor linkage (duplication)
    Incentives for faculty members
     
    Program:
    Absence of well-structured program
    Less developed curriculum
    Collaboration with other skills labs
    Partner with external institution like U of T, Imperial Collage
    Favorable policy and commitment
    Huge inter/intra networking
    Expanding and diversity of graduate studies
    Support from grants [e.g., DelPHE]
    Support from CNIS
    Budget
    Competition within and between faculties
    Brain drain
    IT facilities and Internet access
    Lack of incentives
    Lack of adequate monitoring
  • 40. Infrastructure:
    Skill lab
    inanimate and animal models
    instructional videos
    Faculty:
    Interest of the faculty and leadership in the lab
    Dedicated staff
    Strong support from department members to have the curriculum designed
    Strong interest by faculty and department head
    Interdepartmental cooperation
    Young surgeons who have good energy
    Students:
    Interested students
    Expanding post graduate program
    Infrastructure:
    Financial constraint/Budget
    Single and small skills lab
    Limited resources
    Accessibility to all staff 24/7
    Lack of time
     
    Faculty and staff:
    Management, committed support staff
    Limited and untrained staff
    Less advertised even within faculty
    Administration
    Poor linkage (duplication)
    Incentives for faculty members
     
    Program:
    Absence of well-structured program
    Less developed curriculum
    Collaboration with other skills labs
    Partner with external institution like U of T, Imperial Collage
    Favorable policy and commitment
    Huge inter/intra networking
    Expanding and diversity of graduate studies
    Support from grants [e.g., DelPHE]
    Support from CNIS
    Budget
    Competition within and between faculties
    Brain drain
    IT facilities and Internet access
    Lack of incentives
    Lack of adequate monitoring
  • 41. Next steps (November 2009):
    Assign specific roles
    Program: UTAASC – DelPHE
    Director: Dr. FekadesilassieHenok
    Patron: Dr. DawitDesalegn
  • 42. Director: Dr. FekadesilassieHenok
    Chair the UTAASC Curriculum Committee
    Ensure that the UTAASC Curriculum has regularly scheduled meetings with an advanced agenda and recorded and approved minutes of each meeting.
    Facilitate the individual course participants in completing course planning, implementation and evaluation.
    Ensure that each course participant completes an evaluation.
    Act as the key link between the DelPHE Team and the participants.
    Report regularly with the DelPHE Team on course progress and accomplishments.
  • 43. Patron: Dr. DawitDesalegn
    Oversee the UTAASC Project in Addis
    Report twice yearly to the DelPHE Team regarding project progress and accomplishments.
    Meet regularly with the UTAASC Course Director to review project progress and accomplishments.
    Provide counsel and direction, if requested, to the UTAASC Course Director.
    Facilitate communication through Dr. MiliardDerbew between the British Council in Addis and the DelPHE Team.
  • 44. 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
    • 45. Source book distributed
  • Summary:
    Inactivity
    Internal factors
    • Top down rather than bottom up process
    • 46. SWOT analysis
    • 47. Guide book in preparation
    • 48. 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.