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