164 Innovative, Scalable Educational Model to Improve Out-of-Hospital Care in India

Abstract

The not-for-profit public-private-partnership GVK Emergency Management and Research Institute (GVK EMRI) is the world’s highest-volume ambulance service providing out-of-hospital emergency services across 15 states and 2 union territories in India. Stanford Emergency Medicine International (SEMI) has collaborated with GVK EMRI since 2007 in EMT education, research, and operational capacity building. Through quality assurance research, GVK EMRI and SEMI have identified gaps in the care provided by GVK EMRI EMTs. However, providing in-service training to address these gaps presents a number of challenges: (1) scale with 19,000 EMTs practicing across a geographically expansive country (2) quality and standardization with varying skills of trainers and (3) communication with over 1000 languages spoken nationwide. To address these challenges, we created a series of innovative, mixed-method continuing educational courses (CECs) designed to be delivered over two-days by local Indian trainers after directly observed teaching and feedback by SEMI faculty (Table 1). The third installment of CECs focused on trauma. After a needs assessment and a two-site curriculum pilot, ten video-based lectures were created using animation software (www.powtoons.com). Icons replaced traditional word-based presentations, minimizing translation. To encourage participatory learning, EMTs completed workbooks during videos, which were also followed by standardized case discussions, skill workshops, and low-cost simulations. Students completed pre- and post-multiple choice exams, analyzed by t-test. Content validity was assured by board-certified emergency physicians, who developed and piloted questions. SEMI trained 27 educators from 11 states. Initial trauma CECs taught by Indian trainers to 118 EMTs demonstrated significant improvements (mean knowledge gain: 8 questions, 27% improvement (p<0.0001, Table 2). EMTs and trainers alike preferred this model to traditional teaching methods. Initial results from this training-of-trainers model are promising; however, more data is needed. A formal, rigorous efficacy evaluation is under development with an expected rollout in January 2018.Table 1Stanford Continuing Education Courses for GVK EMRI EMTs1. General Approach to Medical PatientMay 20142. Obstetric and Neonatal CareMay 20153. TraumaJune 20164. PediatricsDec 20165. Communication and LeadershipApril 2017 Open table in a new tab Table 2Trauma Multiple Choice Questions June 2016Location (# of students)Pre-TestPost-TestKnowledge GainMean%StdDev %Mean%StdDev %Mean%Two-tailed P valueHyderabad (57)165314248110827p<0.0001Ahmedabad (61)1755925828827p<0.0001All (118)16541124819827p<0.0001Maximum score for pre and post-test = 30 questions Open table in a new tab