Emergency Care Training
The Options
Kiruja G. Jason
ETAT+ Clinical Manager
Outcomes
• Challenges and opportunities
• Preservice training
• in-service simulated teaching
• E – learning platforms
Preservice training
• Gaps in emergency care training start from pre-service training
• Clinical medicine, colleges offering diploma • 1994 were 3
• 2016 were 35
• Nursing colleges
• 83 colleges in 2017
• Medical schools • 2 in 1994
• 9 in 2016
• National lecturer to student ratio 1:500 (Kippra)
In-service training • Institutions running regular Paediatrics
emergency care courses
• ETAT+ • KPA, UON, KNH, GCH, Kijabe
• APLS / PILS • AKUH, GCH,
• EmONC • MOH partners , Amref
• Trauma • Red-cross
• Certified Courses are expensive
• Catchment 269 Tier 3 and 4 hospitals
Emergency
care
Tier 2
Primary
care
Urgent
referral
Tier
3 and 4
Tier 1
Prevention
Bridging the training Gap
5
Where we are
we do ot e ulize i our OPD, we do ot k ow how to use this a hi e
statement from a county hospital
Where we want to be
we he k our resus itatio equipment daily and run simulation
teachings weekly
The Gap Training and mentorship
Guidelines
Hospital Policies
Where is the evidence pointing
• Effectiveness teaching is enhanced through; • Case based learning
• Clinical simulations
• Practice and feedback
• Repetitive interventions have superior outcomes vs single courses
• Teaching similar to workplace improve skill acquisition (simulations)
• Computer based programs can be as effective as live instruction
• Didactic sessions have little impact on learning outcomes
• Little evidence linking CMEs to improved clinical outcomes • Effective in-service training design and delivery: evidence from an integrative literature review, Biomed Central, Julia Bluestone et al
Opportunities
• Simulation teaching at the ward level
• E-learning platform
Emergency case Simulations in the ward
• To improve patient
• By replacing the real patient through a simulation as opposed to bedside teaching
• The aim of continuous teaching
• You can check state of structures available
• Can be linked to hospital SOPs or care pathways
• Promote of team work
Devolving emergency care training
simulation teaching
• Requirements
• Manikins, low fidelity OK
• Resuscitation equipment
• Frequency > weekly?
• A pool of scenarios
• More than ETAT+
• Simulation guide
• Hospital based manikins and resuscitation equipment
• Hospital based facilitators (need for orientation?)
• Leadership / commitment
Simulation guide • Focus on
• Initial assessment
• Resuscitation
• Airway support
• Breathing support
• Circulation support
• Disability check
• Diagnosis
• Supportive care and other treatment
• Discussion on system improvement
E-learning platforms
Building on Idoc-Africa
Content to interaction.
Local platform being
built through KEMRI-WT
Mobile games and mobile apps
A mobile based training
game is being developed
through KEMRI-WT
E-learning
• Benefits we can get E-learning platforms
• Reduce didactic sessions
• Reduce cost
• Ensure pre-reading is done before live instruction
• Having a requirement that a certain pre-course test score is achieved before attending
the live instruction
• Reach a wider audience
• Faster to review content
• Put up more content
• Vary the content (pre-service and in-service)
Way forward
• Hospitals to invest more in training
• Develop more training scenarios
• KPA, MOH, KEMRI-WT,
•
Comments and questions
Summary
• Hospital / ward level simulations are feasible and effective ways of enhancing emergency care training
• E-learning and mobile based applications have a big potential
• Contacts