High-Fidelity Realistic Acute Medical Simulation and SBAR Training at a Tertiary Hospital in Blantyre, Malawi.

Introduction and Aim Simulation is increasingly recognised as an important tool in medical education, allowing for the practice of clearly defined, easily repeatable scenarios in an immersive fashion without fear of harm. This is particularly important in a low-resource setting whereby junior staff are more likely to be first responders to critically unwell patients, with limited support, without a crash-call system, frequently requiring escalation through the use of a telephone. We aimed to provide and assess the impact of novel high-fidelity, environment- specific postgraduate simulation teaching in Blantyre, Malawi, with significant emphasis placed on common acute scenarios, communication, human-factors and team-working. Description Postgraduate simulation training was delivered to interns, registrars and clinical officers through the use of didactic teaching on A-E assessment and the SBAR handover system, followed by high-fidelity environment-specific scenarios on status-epilepticus, chest-sepsis, DKA and acute asthma. Changes in participant self-rated confidence and knowledge was assessed using Likhert pre/post-course questionnaires, and analysed using a paired t-test on the mean value of responses. 20 participants attended, over 3 days. 100% had a statistically significant improvement in confidence in running an acute situation and using an A-E approach (p Discussion In a low-middle income environment where diagnostic resources may be scarce, with a relative lack of readily-available senior support, workforce training is a key part of health system capacity-building, and simulation forms a valuable yet under-utilised postgraduate educational experience. This is particularly true in Malawi, where the burden of disease is huge, and ratio of qualified clinicians to patients poor. Hence, the course designers were careful to choose not just commonly encountered acute medical scenarios, but also those where impactful treatments would be locally available. We believe this authenticity was key in the significant improvement seen in participant confidence scores for all 4 clinical scenarios, as well as high realism scores. Future research will be invaluable to assess the course’s long-term impact on inpatient safety and care. Furthermore it may be expandable to involve training other allied health-care professionals to allow for similar, positive, team-based learning targets. References . Moodley T, Gopalan D. Airway skills training using a human patient simulator. South African J Anaesth Analg 2014;20(3):147–151. doi:10.1080/22201173.2014.936778 . Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock 2010;3(4):348–352. doi:10.4103/0974-2700.70743 . Nowacki AK, Landes M, Azazh A, Puchalski Ritchie LM. A review of published literature on emergency medicine training programs in low- and middle-income countries. Int J Emerg Med 2013;6(1):26. doi:10.1186/1865-1380-6-26 . World Health Organization. Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies (1st ed.). Geneva: 2011. . Hofmeyr GJ, Haws RA, Bergstrm S, Lee AC, Okong P, Darmstadt GL, Mullany LC, Oo EK, Lawn JE. Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obs 2009 Oct;107 Suppl 1:S21–44, S44-5. doi: 10.1016/j.ijgo.2009.07.017 . Reynolds TA, Mfinanga JA, Sawe HR, Runyon MS, Mwafongo V. Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy 2012;33 Suppl 1(S1):S126–37. doi:10.1057/jphp.2012.41 . Mandeville KL, Ulaya G, Lagarde M, Muula AS, Dzowela T, Hanson K. The use of specialty training to retain doctors in Malawi: A discrete choice experiment. Soc Sci Med 2016;169:109–118. doi:10.1016/j.socscimed.2016.09.034