By Lorraine Anyango and By Beryl Okendo.
Simulation-based- training has successful outcomes in many ways, including confidence boost, enhancement of communication and treatment skills, instilling a mindset that makes preparedness the cornerstone of patient safety, management of stress as well as teamwork skills.
Both pre-service and in-service health workers across various cadres including nurses, clinical officers, anesthetists, medical officers as well as consultants in various specialties are beneficiaries of the simulation Center for Experiential Learning, at Jaramogi Oginga Odinga Teaching and Referral Hospital. (JOOTRH).
Simulation is the production of a computer-based model of something, especially to learn while Simulation-based education is widely recognized as an innovative tool in medical education used to improve patient outcomes.
At the height of the COVID-19 pandemic, the JOOTRH center for Experimental Learning was used to train staff from Kisumu County on COVID-19 screening and management. Practical sessions using the mannequins to demonstrate complex scenarios like acute respiratory distress allowed staff to learn how to escalate oxygen therapy as needed and provide appropriate care to COVID-19 patients while observing personal protective equipment’s (PPE) guidelines to keep themselves safe.
The center was put up in partnership with the Center for Development and Public Health (CPHD), it was first established to support the training of anesthetist nurse providers through a grant provided by the GE Foundation in 2016.
Since then there has been reasonable progress on many fronts, the simulation center has hosted training under the leadership of Dr. Edwin Oduor working together with Ms. Gatwiri Murithi, the Project Manager, of Safe Surgery and Anaesthesia, Centre for public health and Development.
Since its inception, more than 1500 professional medics and medical students within JOOTRH have been trained at the center. The facility caters to the students at the Jaramogi Oginga Odinga medical school, and students from other medical schools including Maseno University of Science and Technology, Uzima University, and Kenya Medical Training College. It has also supported the training of staff from both JOOTRH and the region.
Due to the existence of the center, a partnership to handle pediatric Emergencies Simulation Curriculum was entered in February 2020, the agreement is between Northwestern University (Chicago, IL, USA), and leadership at Maseno University (MU)/JOOTRH.
The agreement’s specific objective was to train Maseno University Pediatric faculty in simulation pedagogy as well as facilitate and debrief simulation cases, Develop simulation scenarios focused on common pediatric emergencies specific to the practice at Maseno University, implement pilot training sessions with medical students, and Culminate the experience with training symposium with pediatric cases led by trained medical students.
The center for Experimental Learning was brilliantly designed as it’s divided into three parts, the first one is Pre- Brief Phase where the facilitator establishes a safe, non-punitive learning environment and orients the learner to the mannequin, technology, roles, and expectations.
The Case is the second phase, where learners interact with the mannequin as if a real patient, case facilitators provide solicited information, and any actors (implanted facilitators) move the case forward as a “Super Nurse” or other roles.
The implanted facilitator provides a key role in facilitating participant engagement and learner suspension of disbelief to promote realism.
Then lastly the debrief Phase where the facilitator solicits learner-driven feedback, highlights key learning points, reinforces positive trainee behaviors, and helps trainees identify areas for improvement.
In terms of technology, the center has an LPN for internet access and has a mixture of low and high-fidelity mannequins specifically infant, adult, and pregnant females.
There are patient monitors and medical equipment for use including an anesthesia machine, a ventilator, and a defibrillator.
Training has been done in obstetric anesthesia care, ACLS, Basic Emergency Course, Introduction to Critical Care, and management of COVID-19 with over 800 healthcare workers from across Western Kenya.
Training has been developed and there are materials to provide individual and team-based training in various specialties including anesthesia, obstetrics and gynecology, pediatrics, emergency medicine, and more recently critical care.
A walk through the center brings you to a learner-centered space equipped with medical equipment relevant to today’s field of medicine. The room is equipped with an automated external defibrillator (AED) and some resuscitation equipment. Learners are guided by step-by-step illustrations and are also allowed to practice hands-on on simulated ‘patients’ including high-fidelity mannequins that mimic a real human.
“The training is vital to all medical professionals and interns because it is the only moment where trial and error can be tolerated within their line of duty.” Ms. Gatwiri said.
Simulation provides a realistic learning environment where they can make mistakes without harming the patient. This makes the learning process more interesting and less strenuous as the learner’s needs can be accommodated by adjusting the learning environment.
Equipped with a modern audiovisual system, learners can be divided into small groups with one group doing the actual simulation and the rest watching and listening via a video link in a separate classroom.
The groups then come together for a debrief where they discuss the case and talk about areas for improvement. The debrief allow learners to self-evaluate and receive feedback from their peers with the facilitator guiding the conversation to ensure that it is in line with the learning objectives and that critique is given positively.
With constant innovation and new knowledge, treatment guidelines, and procedures in the medical field, it is imperative to have strong systems that support continuing medical education (CME) of health workers. This keeps them updated with the knowledge and skills needed not only to provide appropriate care but also to give it promptly. CME is vital to the well-being of healthcare providers – it allows practitioners to improve and develop professionally.
There is a need, however, to decentralize medical training and create vibrant education departments at health facilities. JOOTRH therefore in its mandate as a teaching hospital remains committed to improving the training of medical practitioners. The goal is to support the training of lower-level referral units in a bid to reduce unnecessary referrals that could be managed at county and sub-county hospitals if the staff had the requisite training and competencies.