Feasibility of Simulation-Based Medical Education in a Low-Income Country

Abstract

Summary Statement Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context-appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.

Vital Anaesthesia Simulation Training (VAST); immersive simulation designed for diverse settings

“…The challenges facing SBE in resource-limited settings are significant [7] , yet its potential value in this context is immense [51,52] . VAST's pedagogy is designed to reduce barriers to widespread application of SBE in resource-limited and remote locations and to encourage vivid, experiential learning [53,54] .…”

“…This involves sharing of equipment checklists and a review of available in-country resources. Local simulation support trainees are encouraged to be available 2 days before VAST to work with the visiting team on preparing the [20] Space for facilitator notes; key observations to base the debriefing discussion Supports debriefing by providing structure, a focus on predetermined learning objectives and specific observations from the scenario Teaching materials SBE in resource-limited and remote locations requires dedicated, contextually appropriate, user-friendly teaching materials [7] .…”

“…SBE in resource-limited and remote locations requires dedicated, contextually appropriate, user-friendly teaching materials7. VAST’s clinical content and available equipment is intentionally drawn from a case-mix reflective of care at the district hospital level.…”

“…A simulation center typically includes a dedicate space, skilled staff, sufficient equipment, and technical support [4] , all of which require substantial funding. Successful examples exist where simulation centers have been established in resource-limited settings [5][6][7] ; however, cost and logistical constraints usually preclude widespread delivery of SBE in this manner [8] . Furthermore, reliance on a dedicated center impedes delivery of SBE in rural and remote settings.…”

Simulação em saúde para ensino e avaliação: conceitos e práticas

“…Assim, provavelmente o que é baixo custo para uma universidade nos Estado Unidos é diferente do que é para uma universidade no Brasil. A ideia da construção e validação de alternativas com simuladores de baixo custo, os quais objetivam apresentar um menor custo sem necessariamente perder a qualidade, com a vantagem de necessitar de gasto mínimo para a sua conservação, é viável para países em desenvolvimento na América Latina e África (RAMSEYER; LUTGENDORF;CORTÉS et al, 2019;BULAMBA et al, 2019).…”