Simulation capacity building in rural Indian hospitals: a 1-year follow-up qualitative analysis

Abstract

IntroductionThe benefits of simulation-based medical training are well described. The most effective way to plant and scale simulation training in rural locations remains undescribed. We sought to plant simulation training programmes for anaesthesia emergencies in two rural Indian hospitals.MethodsTwo Indian consultant anaesthetists without experience in medical simulation underwent a 3-day course at the Boston Children’s Hospital’s (BCH) Simulator Program. They returned to their institutions and launched simulation programmes with an airway manikin and mock patient monitor. The 1-year experience was evaluated using individual, in-depth interviews of simulation facilitators. Three staff members (responsible for facilitating medical simulations over the prior year) at two rural hospitals in India were interviewed. None attended the BCH training; instead, they received on-the-job training from the BCH-trained, consultant anaesthetist colleagues.ResultsSuccesses included organisational adoption of simulation training with exercises 1 year after the initial BCH-training, increased interdisciplinary teamwork and improved clinical competency in managing emergencies. Barriers to effective, local implementation of simulation programmes fell into three categories: time required to run simulations, fixed and rigid roles, and variable resources. Thematic improvement requests were for standardised resources to help train simulation facilitators and demonstrate to participants a well-run simulation, in addition to context-sensitive scenarios.ConclusionAn in-person training of simulation facilitators to promote medical simulation programmes in rural hospitals produced ongoing simulation programmes 1 year later. In order to make these programmes sustainable, however, increased investment in developing simulation facilitators is required. In particular, simulation facilitators must be prepared to formally train other simulation facilitators, too.

Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review

“…These factors have effects that extend beyond the operating room and have led to a large brain drain of skilled trainees to other countries in search of more material resources to pursue robust surgical training [5]. This is exacerbated by the difficulty trainees face in accessing relevant literature translated into their language that is context specific to the unique and complex disease presentation in LMICs [6]. Existing solutions to combat this have been proposed, such as development of surgical simulation suites, but these require a significant amount of resources; increasing access to cadaveric and animal model simulations, but this requires additional training and specialized staff; and low-fidelity simulation, but this lacks the sophistication of the advanced techniques used in this field that evolve into more refined approaches of care [7][8][9][10].…”