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The use and effectiveness of high fidelity patient simulators (PS) in preclinical medical education has not been as well studied as during the clinical years. The goal of this study was to determine whether a simulation activity (SIM) would enhance learning of cardiovascular function curves and acid base physiology better than a paper, clinical case conference (Con). Both the SIM and Con focused on the same clinical cases (heart failure in the CV module and COPD in the pulmonary module).MethodsThe Year 1 medical student class (n=192) was divided approximately into two halves with half doing a Con (group A) and the other half doing a SIM during the CV module (group B). During the pulmonary module group A did the SIM while group B did the Con. Switching of the groups allowed student participation in both modes of learning and served as a control. Student learning was assessed by performance on a quiz/exam question pertaining to the modules. We also asked a survey question to assess student perception of learning.ResultsA higher % of students in the SIM groups got the correct answer on both the cardiac module quiz (64.6% vs. 56.0%) and on the pulmonary module exam (77.6% vs. 72.3%) than students participating in the Con. Despite the higher % of students getting the answer correct following the SIM, student perception was that they had not learned the material as well in the SIM center. The only outstanding exception was that they felt that the SIM helped them to realize the importance of teamwork more than the Con.ConclusionThese data suggest that SIM activities may facilitate student understanding of CV function curves and acid base physiology better than a paper, clinical case Con. Additionally, SIM activities may be an avenue to develop team building skills in the preclinical years.

The aim of this study was to evaluate the impact on knowledge reinforcement and learner satisfaction of a simulation-based training session versus an image-based lecture, for normal delivery and shoulder dystocia management. Thirty training midwifes participated in the study. Three weeks after a 3-hour "labor and delivery" theoretical class, trainees were randomly assigned to one of two groups. Four were excluded after randomization. The first group (nϭ12) participated in a 30-minute image based lecture and the second group (nϭ14) was divided in pairs attending a 30-minute birthing simulator session (Noelle , Gaumard, Inc., USA). Both classes focused on management of normal delivery and manoeuvres for shoulder dystocia resolution.A 10-question multiple-choice test was performed just before (pre-test) and after (posttest) both sessions. Learner satisfaction was studied by adding a 6-question questionnaire to the post-test, with a 7 th additional question applied to the lecture group after they attended a compensatory simulation session one week later. Satisfaction score was obtained through a five point Likert scale. For statistical analysis the "one-way" ANOVA tests was used setting significance at pϽ0.05. Simulation group post-test mean was significantly higher than in the lecture group: 7.21 versus 5.83 (pϭ0.03). Mean score progression between tests was also higher in the simulation group, but the difference did not reach statistical significance: 3.14 versus 2.33 (pϭ0.28). There was no difference between groups in learner satisfaction (4.16 versus 4.09, pϭ0.61). However, the lecture group, when questioned after their compensatory simulation session, considered simulation to be a much more useful tool (mean score was 4.6).We concluded that this study suggests better reinforcement of knowledge in simulatorbased sessions as compared to image-based lectures, for post-graduate training of normal delivery and shoulder dystocia management. A higher study sample size is needed to confirm this result. Oral Presentation # 2 Does simulation training improve communication with a simulated patient during an obstetric emergency?Chris Bartlett, Denise Ellis, Jo Crofts, Mark James The SaFE Study Obstetric emergencies differ from anaesthetic emergencies; during most obstetric emergencies the patient is not anaesthetised. Simulation is increasingly used for obstetric training; however it is difficult to include communication with the patient using human patient simulators (HPS).METHOD: 140 staff from 6 hospitals were randomized into 24 teams. Teams underwent one of four obstetric training courses; a one day clinical course in local hospitals or at a simulation centre, or a two day clinical and teamwork course in local hospitals or at a simulation centre. Training at the simulation centre used HPSs; training locally used patient-actors. Teams were evaluated pre and post-training managing an eclampsia and PPH drill. The team's communication with the patient was evaluated by the patient-actor during the drill using a 5-point Like...

their needs and organizing strategies to meet those needs to a desired performance. There is inadequate evidence on interest, level of influence and effects of participation on facility performance. This study sought to explore the structures, intrests and level of influnce of collaborative level representatives in provision of primary care services in Uasin Gishu County Structure/Method/Design: Case Study Methodology. Five primary health care facilities were selected purposively, from the six different sub-Counties. Study population included health facility committee representatives and other stakeholders working to represent community members in health activities. Data collection was through observation, Key Informant interviews, informal group discussions and review of documents including minutes.. Data was captured using audio recording, pictures, notetaking and a reflective journal. Data was and transcribed cleaned coded and analyzed into emerging themes. Findings: A total of 26 respondents were interviewed, and minutes of 5 facilities for s reviewed of the past 2 years starting 2014. Attended 3 public health public participation activities, and sat in three meetings. Health Facility Committee is the main formal government structure for community members to participate. There was no formal schedule for meetings attendance except for one facility. Committee mainly meet when there is funds for facility or any project going on. The facility committee's members participated majorly in projects as opposed to day to day functioning of facility. The committee members generally attended all meetings funds. Committee members with bigger influence were former political leaders or retired government officials. They are also able to lobby with government for mainly infrastructure support Sometimes the committee members whistle blow on lack of drugs or shortage of facilities to political leaders like Governor. Outcome & Evaluation: Structures of collaborative representation should be strengthened. A coordinated and collaborative response is required to tackle the complexity collaborative participation. Collaborative participation is a delicte process and needs strentnening for representation of community inteests Going Forward: Community has some level of influce which utimately affects the service delivery. Source of Funding: Consortium for Advanced Research Training in Africa (CARTA). Future heath systems.