What is needed for taking emergency obstetric and neonatal programmes to scale?

Bergh, Anne‐Marie; Allanson, Emma; Pattinson, Robert Clive

doi:10.1016/j.bpobgyn.2015.03.015

Cited by 18 publications

(24 citation statements)

References 56 publications

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“…Specific areas that would benefit from future research include the implementation of simulation [70] and the interplay between and the role of local organisers of simulations and of simulation centres. Research would profit greatly by encouraging collaboration between practical organisers of simulations and medical education researchers.…”

Section: Discussionmentioning

confidence: 99%

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

et al. 2017

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BackgroundSimulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations.DiscussionNon-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed.SummaryBased on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.

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Section: Discussionmentioning

confidence: 99%

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

et al. 2017

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“…Supervision in the form of on-site support can improve quality of care by improving the knowledge and skills of providers (24, 25). The system of support developed in the mentoring program can inform models of national supportive supervision, which have yet to be fully developed in Laos.…”

Section: Methodsmentioning

confidence: 99%

“…In the current system, there are quarterly supervision and monitoring visits from the province to the districts, and the districts to the health centers. However, the focus tends to be observation and surveillance rather than support and capacity building, as has been noted elsewhere (25). Thus, there is an opportunity to incorporate a mentoring approach to these routine visits.…”

Section: Methodsmentioning

confidence: 99%

Developing a Mentorship Program in Laos

Catton¹

2017

Front. Public Health

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Skills strengthening and capacity building for maternal and newborn health (MNH) providers are essential to ensure quality care for mothers and newborns. There is, however, limited research regarding what constitutes an effective model in low-income countries. The Lao People’s Democratic Republic (Laos) has some of the region’s worst outcomes for neonatal and maternal mortality. Moreover, with a 23-year hiatus in midwifery training, which ended approximately 7 years ago, there is a cadre of new and inexperienced midwives in practice without support systems, skills, or continuing professional development opportunities. Traditional didactic teaching methodologies prevail in Laos, but with little evidence of efficacy. As an alternative model, Save the Children International has been implementing a mentorship approach for MNH providers in two provinces in northern Laos since January 2016, with technical guidance and funding from the United States Agency for International Development-supported global Maternal Child Survival Program. This community case study will describe and reflect on the approach by highlighting the need and rationale for mentorship, followed by a description of the program’s core components and the results observed so far. Lessons learned and the application of the approach to different contexts and health-care professionals, considering both constraints and opportunities, will be discussed.

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“…From the Kirkpatrick classification it can be concluded that sufficient evidence exists that Scaling up a training package across a health system beyond the original limited number of testing sites and maintaining the same high quality required for a scientific study remains problematic for both HICs and LMICs [82,83]. Ni Bhuinneain and McCarthy refer to a possible short-term Hawthorne effect with unsustainable outcomes on a larger scale [70].…”

Section: Future Agendamentioning

confidence: 99%

“…Policies enabling or supporting the implementation of EMONC training packages are essential [33,50,69,83], as well as supportive work environments and across-the-board participation at all levels of the health system [39]. Choosing realistic low-tech training equipment may facilitate onsite training because of a more equal distribution of available resources that can enable more appropriate training for a greater number of healthcare workers.…”

Section: Future Agendamentioning

confidence: 99%

What is the impact of multi-professional emergency obstetric and neonatal care training?

Bergh

Baloyi

Pattinson

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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This paper reviews evidence regarding change in healthcare-provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed -5 randomised controlled trials, 2 quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in highincome countries and adapted for use in low-and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all healthcare providers. The challenges are: scaling up such training to all institutions; sustaining regular in-service training; integrating training into institutional and health-system patient-safety initiatives; and 'thinking-out-of-the-box' in evaluation research.

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What is needed for taking emergency obstetric and neonatal programmes to scale?

Cited by 18 publications

References 56 publications

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation

Developing a Mentorship Program in Laos

What is the impact of multi-professional emergency obstetric and neonatal care training?

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