A tool to improve competence in the management of emergency patients by rural clinic health workers: a pilot assessment on the Thai-Myanmar border

Abstract

BackgroundShoklo Malaria Research Unit has been providing health care in remote clinics on the Thai-Myanmar border to refugee and migrant populations since 1986 and 1995, respectively. Clinics are staffed by local health workers with a variety of training and experience. The need for a tool to improve the competence of local health workers in basic emergency assessment and management was recognised by medical faculty after observing the case mix seen at the clinic and reviewing the teaching programme that had been delivered in the past year (Jan-13 to March-14).AimsTo pilot the development and evaluation of a simple teaching tool to improve competence in the assessment and management of acutely unwell patients by local health workers that can be delivered onsite with minimal resources.MethodsA structured approach to common emergencies presenting to rural clinics and utilizing equipment available in the clinics was developed. A prospective repeated-measures observed structured clinical examination (OSCE) assessment design was used to score participants in their competence to assess and manage a scenario based ‘emergency patient’ at baseline, immediately post-course, and 8 weeks after the delivery of the teaching course. The assessment was conducted at 3 clinic sites and staff participation was voluntary. Participants filled out questionnaires on their confidence with different scenario based emergency patients.ResultsAll staff who underwent the baseline assessment failed to carry out the essential steps in initial emergency assessment and management of an unconscious patient scenario. Following delivery of the teaching session, all groups showed improved competence in both objective assessment and subjective confidence levels.ConclusionsStructured and practical teaching and learning with minimal theory in this resource limited setting had a positive short-term effect on the competence of individual staff to carry out an initial assessment and manage an acutely unwell patient. Health-worker confidence likewise improved. Workplace assessments are needed to determine if this type of skills training impacts upon mortality or near miss mortality patients at the clinic.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-015-0041-x) contains supplementary material, which is available to authorized users.

Video-based feedback as a method for training rural healthcare workers to manage medical emergencies: a pilot study

“…Shoklo Malaria Research Unit provides mainly maternal and neonatal care in Mae La, the largest refugee camp in Thailand, with an estimated population of 45,000. The main health provider in Mae La camp at the time of this training was Première Urgence – Aide Médicale Internationale [ 33 ]. Wang Pha and Mawker Thai clinics provide more general basic health care for the Burmese and Karen migrant population, and have adult inpatient and outpatient care facilities in rural and remote locations.…”

“…Therefore, staff exposure to managing the acutely comatose, or convulsing medical emergencies has reduced significantly. Sepsis and obstetric and neonatal emergencies commonly present to the clinics [ 33 ].…”

“…A previous pilot study was carried out by Stanley et al 2015 [ 33 ] to teach rural clinic healthcare workers at Shoklo Malaria Research Unit’s three clinics to manage emergency scenarios using the ABCDE approach. Based on the limitations of the pilot study, especially the cultural barriers to feedback in Asia ( ‘loss of face’ ) [ 36 ], the use of video simulation as a means of improving quality of care was broached.…”

“…The current pilot study builds on work from a previous study which looked at the use of a structured ABCDE approach to train rural staff in three clinics along the Thai-Myanmar border [ 33 ]. Whilst the previous study relied on didactic teaching and the Observed Structured Clinical Examination (OSCE) method of assessment with verbal feedback, we explore the use of video-assisted feedback and low fidelity simulation as a means of training rural healthcare workers in Thailand and PNG to manage medical emergencies effectively.…”

Impact of the World Health Organization Basic Emergency Care Course in Tanzania and Uganda

“…Lack of adequate training equipment due to international transport of mannequins has decreased satisfaction of other short courses, something we overcame by utilizing locally sourced equipment [25]. Short and directed interventions such as case-based training have been shown to be effective in low-resource settings such as the Thai-Myanmar border, which could be a sustainability model for ongoing BEC refresher training [26].…”