Teaching the Trainers in Simulation Based Education:  Barriers and Solutions Dubrowski A., MiliardDerbew, Byrne N., Pittin...
Ethiopia<br />	Maternal mortality ratio in 2005  (lifetime risk of maternal death) was 1 in 27<br />	720 of every 100,000 ...
Ethiopia<br />	Maternal mortality ratio in 2005  (lifetime risk of maternal death) was 1 in 27<br />720 of every 100,000 b...
The World Health Organization (WHO) estimates that the majority of fatalities and disabilities could be prevented if deliv...
The goal of a partnership between Addis Ababa University, University of Toronto, and Imperial College London is to develop...
										 simulation<br />         				 	 		  	Replication of a task or an event for the purpose of training or evaluatio...
November 2006<br />Medical Education, 2009<br />
t=2.81, p=.012<br />t=3.42, p=.003<br />25<br />14<br />20<br />12<br />10<br />15<br />8<br />Checklists<br />GRS<br />10...
Pre-training<br />Post-training<br />
In November 2008 a group of individuals representing the three partners conducted an extensive environmental scan and stak...
Three primary objectives during this meeting were:<br />To identify current use of simulation resources in the Surgical Si...
Methods: <br />The group met with four groups of stakeholders:<br />Trainees from medicine, surgery, OBGYN, nursing and mi...
Results: <br />The undergraduate medical program and surgical residency utilize the SSL extensively by:<br />Following the...
Results: <br />Four significant areas for future development were identified: <br />Development and implementation of reli...
Conclusion:<br />
The collective expertise within the partnership group will be applied to the development of Train the Tr...
Planned activities:  <br />Year 1: “This is how we do it”<br />March 2009:  Train the Trainer workshop<br />March 2009:  I...
Planned activities:  <br />Year 2: “Now it is your turn”<br />A selected group will be asked to re-develop the workshop (o...
Planned activities:  <br />Year 3: “Sustainability”<br />Evaluation of the program.  <br />Exporting the program to other ...
In March 2009 a group of individuals from Toronto lead a 3 day hands on Train the Trainer course on simulation-based progr...
Summary:  <br />The course was graduated by 12 clinicians and 2 administrators. <br />UTAASC was formed.<br />
Inactivity<br />External factors<br />Lack of follow up from us<br />Internal factors<br />Top down rather than bottom up ...
Next steps (November 2009):  <br />Distribution of a source book<br />Development of a guide book<br />Environmental re-sc...
Next steps (November 2009):  <br />Distribution of a source book<br />
Next steps (November 2009):  <br />Development of a Guide book<br />Basic Technical Skills [e.g. Suturing, IV Catheterizat...
Next steps (November 2009):  <br />Environmental re-scan and stakeholder re-analysis<br />
Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of...
Infrastructure:<br />Financial constraint/Budget<br />Single and small skills lab<br />Limited resources and times<br />Ac...
Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of...
Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of...
Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of...
Next steps (November 2009):  <br />Assign specific roles<br />Program: UTAASC – DelPHE<br />Director: Dr. FekadesilassieHe...
Director: Dr. FekadesilassieHenok<br />Chair the UTAASC Curriculum Committee<br />Ensure that the UTAASC Curriculum has re...
Patron: Dr. DawitDesalegn<br />Oversee the UTAASC Project in Addis<br />Report twice yearly to the DelPHE Team regarding p...
Summary:  <br />Inactivity<br />External factors<br /><ul><li>Lack of follow up from us</li></ul>Internal factors<br /><ul...
Source book distributed</li></li></ul><li>Summary:  <br />Inactivity<br />Internal factors<br /><ul><li>Top down rather th...
SWOT analysis
Guide book in preparation
Governance of the program established</li></li></ul><li>Significance: <br />With proper implementation, this program will ...
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Dubrowski 1 SSE

  1. 1. Teaching the Trainers in Simulation Based Education: Barriers and Solutions Dubrowski A., MiliardDerbew, Byrne N., Pittini R., Satterthwaite L., and Tajirian T. <br /> Roger Kneebone <br />Alison Barnet <br />Fernando Bello<br /> <br />Supported by DelPHE<br />
  2. 2. Ethiopia<br /> Maternal mortality ratio in 2005 (lifetime risk of maternal death) was 1 in 27<br /> 720 of every 100,000 births result in maternal death.<br />Canada<br />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.<br />
  3. 3. Ethiopia<br /> Maternal mortality ratio in 2005 (lifetime risk of maternal death) was 1 in 27<br />720 of every 100,000 births result in maternal death.<br />Canada<br />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.<br />
  4. 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.<br />Guilbert JJ. The World Health Report 2006: working together for health. Educ Health (Abingdon). 2006;19(3):385-7.<br />
  5. 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.<br />
  6. 6. simulation<br /> Replication of a task or an event for the purpose of training or evaluation<br />
  7. 7. November 2006<br />Medical Education, 2009<br />
  8. 8. t=2.81, p=.012<br />t=3.42, p=.003<br />25<br />14<br />20<br />12<br />10<br />15<br />8<br />Checklists<br />GRS<br />10<br />6<br />Post-test<br />4<br />Pre-test<br />5<br />2<br />0<br />0<br />
  9. 9. Pre-training<br />Post-training<br />
  10. 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. <br />
  11. 11. Three primary objectives during this meeting were:<br />To identify current use of simulation resources in the Surgical Simulation Laboratory (SSL, The Black Lion hospital, Faculty of Medicine, Addis Ababa University),<br />to identify potential areas for faculty development (Train the Trainer) programs to enable optimal use of the SSL, and<br />to develop a plan for Train the Trainer program and its implementation.<br />
  12. 12. Methods: <br />The group met with four groups of stakeholders:<br />Trainees from medicine, surgery, OBGYN, nursing and midwifery – current and potential users of the SSL,<br />faculty members from medicine, surgery, OBGYN, nursing and midwifery – current and potential users of the SSL,<br />university governance,<br />external stakeholders: CINS, and British Council.<br />The group also visited the site and participated in a training session in the facility.<br />
  13. 13. Results: <br />The undergraduate medical program and surgical residency utilize the SSL extensively by:<br />Following the Essentials of Surgical Skills (ESS),<br />providing self-guided learning opportunities to students,<br />providing special skills training (e.g., laparoscopic skills)<br />encouraging other departments including OBGYN, nursing and midwifery to become involved in skills training courses.<br />
  14. 14. Results: <br />Four significant areas for future development were identified: <br />Development and implementation of reliable and valid learner assessments, <br />Implementation of learner-centered educational approaches,<br />implementation of more realistic forms of simulation training,<br />shift towards inter and multi professional simulated training.<br />
  15. 15. Conclusion:<br />
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. <br />
  16. 16. Planned activities: <br />Year 1: “This is how we do it”<br />March 2009: Train the Trainer workshop<br />March 2009: Independent research studies indentifying institutional facilitators for the progress and the effectiveness of the program (Drs. MaisamFazel).<br />
  17. 17. Planned activities: <br />Year 2: “Now it is your turn”<br />A selected group will be asked to re-develop the workshop (objectives  simulation  evaluation)<br />Tangible outcome: Train the Trainer Guidebook <br />2-day module in advanced assessment in evaluation and new simulation approaches (contextualized simulation).<br />
  18. 18. Planned activities: <br />Year 3: “Sustainability”<br />Evaluation of the program. <br />Exporting the program to other schools in Ethiopia and Sub-Saharan Africa.<br />
  19. 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. <br />
  20. 20.
  21. 21.
  22. 22.
  23. 23.
  24. 24.
  25. 25.
  26. 26.
  27. 27. Summary: <br />The course was graduated by 12 clinicians and 2 administrators. <br />UTAASC was formed.<br />
  28. 28. Inactivity<br />External factors<br />Lack of follow up from us<br />Internal factors<br />Top down rather than bottom up process<br />
  29. 29. Next steps (November 2009): <br />Distribution of a source book<br />Development of a guide book<br />Environmental re-scan and stakeholder re-analysis<br />Assign specific roles<br />
  30. 30. Next steps (November 2009): <br />Distribution of a source book<br />
  31. 31.
  32. 32.
  33. 33. Next steps (November 2009): <br />Development of a Guide book<br />Basic Technical Skills [e.g. Suturing, IV Catheterization]<br />Perineal Tear Repair<br />Instrumental Delivery<br />C-section<br />Abortion Care<br />
  34. 34. Next steps (November 2009): <br />Environmental re-scan and stakeholder re-analysis<br />
  35. 35.
  36. 36. Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of the faculty and leadership in the lab<br />Strong support from department members to have the curriculum designed<br />Strong interest by faculty and department head<br />Interdepartmental cooperation<br />Students:<br />Interested students<br />Expanding post graduate program<br />
  37. 37. Infrastructure:<br />Financial constraint/Budget<br />Single and small skills lab<br />Limited resources and times<br />Accessibility to all staff 24/7<br /> <br />Faculty and staff:<br />Management<br />Limited and untrained staff<br />Less advertised even within faculty<br />Poor linkage <br />Incentives for faculty members<br /> <br />Program:<br />Absence of well-structured program<br />Under-developed curriculum<br />Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of the faculty and leadership in the lab<br />Dedicated staff<br />Strong support from department members to have the curriculum designed<br />Strong interest by faculty and department head<br />Interdepartmental cooperation<br />Young surgeons who have good energy<br />Students:<br />Interested students<br />Expanding post graduate program<br />
  38. 38. Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of the faculty and leadership in the lab<br />Dedicated staff<br />Strong support from department members to have the curriculum designed<br />Strong interest by faculty and department head<br />Interdepartmental cooperation<br />Young surgeons who have good energy<br />Students:<br />Interested students<br />Expanding post graduate program<br />Infrastructure:<br />Financial constraint/Budget<br />Single and small skills lab<br />Limited resources<br />Accessibility to all staff 24/7<br />Lack of time<br /> <br />Faculty and staff:<br />Management, committed support staff<br />Limited and untrained staff<br />Less advertised even within faculty<br />Administration<br />Poor linkage (duplication)<br />Incentives for faculty members<br /> <br />Program:<br />Absence of well-structured program<br />Less developed curriculum<br />Collaboration with other skills labs<br />Partner with external institution like U of T, Imperial Collage<br />Favorable policy and commitment<br />Huge inter/intra networking<br />Expanding and diversity of graduate studies<br />Support from grants [e.g., DelPHE]<br />Support from CNIS<br />
  39. 39. Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of the faculty and leadership in the lab<br />Dedicated staff<br />Strong support from department members to have the curriculum designed<br />Strong interest by faculty and department head<br />Interdepartmental cooperation<br />Young surgeons who have good energy<br />Students:<br />Interested students<br />Expanding post graduate program<br />Infrastructure:<br />Financial constraint/Budget<br />Single and small skills lab<br />Limited resources<br />Accessibility to all staff 24/7<br />Lack of time<br /> <br />Faculty and staff:<br />Management, committed support staff<br />Limited and untrained staff<br />Less advertised even within faculty<br />Administration<br />Poor linkage (duplication)<br />Incentives for faculty members<br /> <br />Program:<br />Absence of well-structured program<br />Less developed curriculum<br />Collaboration with other skills labs<br />Partner with external institution like U of T, Imperial Collage<br />Favorable policy and commitment<br />Huge inter/intra networking<br />Expanding and diversity of graduate studies<br />Support from grants [e.g., DelPHE]<br />Support from CNIS<br />Budget<br />Competition within and between faculties<br />Brain drain<br />IT facilities and Internet access <br />Lack of incentives<br />Lack of adequate monitoring<br />
  40. 40. Infrastructure: <br />Skill lab<br />inanimate and animal models<br />instructional videos <br />Faculty:<br />Interest of the faculty and leadership in the lab<br />Dedicated staff<br />Strong support from department members to have the curriculum designed<br />Strong interest by faculty and department head<br />Interdepartmental cooperation<br />Young surgeons who have good energy<br />Students:<br />Interested students<br />Expanding post graduate program<br />Infrastructure:<br />Financial constraint/Budget<br />Single and small skills lab<br />Limited resources<br />Accessibility to all staff 24/7<br />Lack of time<br /> <br />Faculty and staff:<br />Management, committed support staff<br />Limited and untrained staff<br />Less advertised even within faculty<br />Administration<br />Poor linkage (duplication)<br />Incentives for faculty members<br /> <br />Program:<br />Absence of well-structured program<br />Less developed curriculum<br />Collaboration with other skills labs<br />Partner with external institution like U of T, Imperial Collage<br />Favorable policy and commitment<br />Huge inter/intra networking<br />Expanding and diversity of graduate studies<br />Support from grants [e.g., DelPHE]<br />Support from CNIS<br />Budget<br />Competition within and between faculties<br />Brain drain<br />IT facilities and Internet access <br />Lack of incentives<br />Lack of adequate monitoring<br />
  41. 41. Next steps (November 2009): <br />Assign specific roles<br />Program: UTAASC – DelPHE<br />Director: Dr. FekadesilassieHenok<br />Patron: Dr. DawitDesalegn<br />
  42. 42. Director: Dr. FekadesilassieHenok<br />Chair the UTAASC Curriculum Committee<br />Ensure that the UTAASC Curriculum has regularly scheduled meetings with an advanced agenda and recorded and approved minutes of each meeting.<br />Facilitate the individual course participants in completing course planning, implementation and evaluation.<br />Ensure that each course participant completes an evaluation.<br />Act as the key link between the DelPHE Team and the participants.<br />Report regularly with the DelPHE Team on course progress and accomplishments. <br />
  43. 43. Patron: Dr. DawitDesalegn<br />Oversee the UTAASC Project in Addis<br />Report twice yearly to the DelPHE Team regarding project progress and accomplishments.<br />Meet regularly with the UTAASC Course Director to review project progress and accomplishments. <br />Provide counsel and direction, if requested, to the UTAASC Course Director.<br />Facilitate communication through Dr. MiliardDerbew between the British Council in Addis and the DelPHE Team.<br />
  44. 44. Summary: <br />Inactivity<br />External factors<br /><ul><li>Lack of follow up from us</li></ul>Internal factors<br /><ul><li>Top down rather than bottom up process</li></li></ul><li>Summary: <br />Inactivity<br />External factors<br /><ul><li>Lack of follow up from us
  45. 45. Source book distributed</li></li></ul><li>Summary: <br />Inactivity<br />Internal factors<br /><ul><li>Top down rather than bottom up process
  46. 46. SWOT analysis
  47. 47. Guide book in preparation
  48. 48. Governance of the program established</li></li></ul><li>Significance: <br />With proper implementation, this program will create cohorts of local trainers proficient in using simulation for training of clinical skills.<br />This proficiency will lead to self-sustainable programs with Ethiopian and Sub Saharan appropriate content and methods.<br />
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