Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal

Wang, Alfred; Saltarelli, Nicholas; Cooper, Dylan; Amatya, Yogendra; House, Darlene R.

doi:10.15766/mep_2374-8265.10924

Cited by 4 publications

(2 citation statements)

References 15 publications

(17 reference statements)

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“…In 2015, only four individuals had completed their postgraduate training in emergency medicine in Nepal [7]. However, new programs and initiatives have been implemented in Kathmandu, where collaborative international emergency medicine training has been established [32], and new research studies have emerged describing possible points of improvement in the emergency medicine curriculum [33]. Even though research on Nepalese emergency medicine and treatment has emerged, most studies are conducted in Kathmandu with only a few studies coming from the remaining part of Nepal.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Hansen

Bratholm²,

Pradhan³

et al. 2022

Int J Emerg Med

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Background Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience challenges or barriers in their treatment of patients. This study aimed to investigate physicians’ perspectives on emergency and prehospital patient management in a low-income country, Nepal, and to understand the challenges and barriers they perceive in emergency treatment including both the prehospital treatment and the immediate in-hospital treatment at the emergency department. Methods Using a qualitative study, eight semi-structured interviews with physicians working in a Nepalese emergency department were performed. The interviews were conducted between September and November 2021 and were audio-recorded and transcribed verbatim. Data were subsequently analyzed using the systematic text condensation method. Results Four main themes and associated sub-themes were identified: (1) patients’ sociocultural, educational, and financial factors (such as financial issues and financial inequality) and regional differences; (2) emergency department’s organization and resources concerning human and material resources, protocols, and guidelines; (3) problems with the emergency department (ED) service’s qualities and availability caused by an insufficient integration of the ED and the EMS, prehospital resources, and financial interests in the EMS; and (4) surrounding healthcare system’s impact on the ED where, especially, the levels of organized primary care, governmental responsibilities, and healthcare structure were addressed. Conclusions The physicians identified numerous regularly encountered challenges and barriers. These challenges stretched beyond the ED and into various aspects of society. The patients’ financial problems were described as the greatest problem, restricting the treatment due to a given patient’s inability or unwillingness to pay for the required procedures. The physicians were thus restricted in completing their duties to the desired levels. The low quality of prehospital care and a lack of education and awareness of common diseases and symptoms in a significant proportion of patients were identified by many participants as being significant issues. The aforementioned challenges or barriers directly resulted in patients arriving in critical conditions that could have been avoided if the disease were treated earlier.

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Section: Discussionmentioning

confidence: 99%

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Hansen

Bratholm²,

Pradhan³

et al. 2022

Int J Emerg Med

View full text Add to dashboard Cite

show abstract

“…Skill labs or simulation centers are not essential for a high-quality simulation session, in fact Wang et al (24) demonstrated that a sustainable simulation lab can be constructed and potentially play a supportive role in developing an emergency medicine curriculum even in countries with limited resources. Further, team-based sessions with experienced facilitators can add to the realism of simulation scenarios and deepen the degree of participant immersion.…”

Section: Crisis Resource Managementmentioning

confidence: 99%

Role of Simulation in Italian Emergency Medicine training programs: data from a national survey

Cascio

Ingrassia²,

Zaccaria

et al. 2023

Preprint

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Background Simulation is an educational tool widely used worldwide and simulation-based education is an important training strategy in Emergency Medicine (EM) training programs. Objective In the first part of the project SIMinMEU of CosMEU and SIMMED, an electronic survey open to the Italian EM residents’ representatives was created with the aim to assess their awareness about simulation in their programs. Results Out of 33 EM residencies, 30 representatives answered the survey. Only 15 schools offer simulation, with a median of 16,27 (range 0–46) annual simulation training, with 53% of representatives indicating that the time dedicated to it met their needs. 15 do skill lab activities (50 %), 14 do High fidelity simulation (46.66%), one does serious games (3,33%) and one does virtual reality (3,33%). In situ simulations aren’t provided. Crisis resource management (CRM) and soft skills are topics covered in seven (23,3%). In 5 residencies (16,6%) there are certified facilitators. The annual exams aren’t carried out using simulation. Only in five (16,6%) residencies research in simulation is carried out. Residents’ satisfaction for simulation activities is lower than good in 73% of cases. Most residents stated lack of simulation standards and poor quality of simulation activities. The main requests are that simulation must be part of the teaching program, increased in number and better structured. Conclusions Considering the increasing interest of residents in simulation emerged by this survey, CoSMEU and SIMMED will commit to improving the quality, facilitating the spreading and guaranteeing the standardization of simulation in every EM Italian school.

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Challenges and opportunities in the uptake of simulation in healthcare education in the developing world: a scoping review

Ismail,

Ajani,

Baqir

et al. 2024

MedEdPublish

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Background Simulation is increasingly being adopted by healthcare educators throughout the developed world as it offers a safe environment to practice skills. While there is literature on learning via simulation in healthcare in the developed world, more studies are required to investigate the factors influencing this approach in the developing world. Objective This scoping review highlights the key factors that act as deterrents as well as encouragement to the uptake of simulation as a teaching methodology in healthcare education in developing countries. Design The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched between January 2000 and January 2024 for research articles published in peer reviewed English language journals using a combination of keywords. Results A total of 48 articles were included in the final analysis. Challenges and opportunities were divided into professional, academic, and resource-based factors, and their individual sub-themes. The main challenges reported were the lack of a contextual curriculum, content heavy curricula, dearth of trained simulationists and cost of simulators. Performance anxiety was an important challenge reported by both trainers and trainees. Main opportunities were an interest in adopting simulation-based education from both trainers and trainees, and the opportunity to improve patient safety and quality of education. Other findings were that academic leadership and faculty show interest and urgency to adopt simulation in curricula and allocate funds for this. Facilitators need to be provided with protected time to become simulationists. Local manufacturers need to be sourced for simulators, and transfer of technology and expertise needs to be negotiated. Conclusion Simulation needs to be looked at from the lens of not only education, but more importantly of patient safety in developing countries to allow simulation-based education to be mainstreamed in health professions education in low- and middle-income contexts.

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Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal

Cited by 4 publications

References 15 publications

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

Role of Simulation in Italian Emergency Medicine training programs: data from a national survey

Challenges and opportunities in the uptake of simulation in healthcare education in the developing world: a scoping review

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