Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group

Abstract

BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.

Overview of a novel paediatric surgical simulation‐based medical education programme in Myanmar

“…Although the authors included qualitative data collection in addition to scoping review, it is likely that this did not capture all relevant LMICs SBME activities. However, it did reveal a distinct lack of surgically focused interventions 11 …”

“…A scoping review and survey conducted by Puri et al revealed that its utilization is centred around either medical education, training and evaluation or the use of simulated participants. 11 Although the authors included qualitative data collection in addition to scoping review, it is likely that this did not capture all relevant LMICs SBME activities. However, it did reveal a distinct lack of surgically focused interventions.…”

“…However, it did reveal a distinct lack of surgically focused interventions. 11 Based on previous activities in the region, Monash Children's Hospital International received a formal invitation to conduct an initial course in Myanmar with a paediatric surgical focus. There is an ongoing shortage of paediatric surgeons in Myanmar.…”

Real challenges in virtual worlds

“…They send a clear message that good-looking simulation models are insufficient, and that robust evidence based on standardised measures are necessary for the field to advance, for it to get buy-in from health professionals and for it to be properly implemented in modern healthcare. Puri et al 3 make a similar case for advancing care in low-income and middle-income countries, and also that the scope of what might be called frugal simulations be widened to benefit many types of endeavour, a role that international agencies could champion (see figure 2). …”

Spearheading Simulation in a Middle-Income Country: An International Collaboration

“…According to Andreatta (2017), the perks of using simulation may be even more substantial in these settings given greater disparities between the delivery of high-quality health care and patient access to that care. Although a recent literature review of health care simulation in LMIC concluded that simulation in these settings is feasible and promising, simulation in LMICs is not currently in widespread use and remains an area of opportunity for improving health care quality (Martinerie et al, 2018;Puri et al, 2017). One major barrier to the uptake of simulation in LMICs is the considerable personnel and financial resources needed for initiating and maintaining a program (Avila-Guerra, 2014).…”