Board 355 - Research Abstract Training Non-Physician Anesthetists Using Medical Simulation In Freetown, Sierra Leone (Submission #1140)

Abstract

Introduction/Background Medical simulation is a proven, powerful tool that is increasingly being used for training healthcare workers worldwide. Unfortunately, high-fidelity simulation has predominately remained an instrument found in high resource countries and experience with simulation for medical training in austere environments remains primarily anecdotal,1 and has not been extensively documented in the scientific literature.2,3 Anesthesia delivery in Sierra Leone, as with many other countries in Sub-Saharan Africa and worldwide, is performed primarily by non-physicians with two years of anesthesia training in a traditional apprenticeship model consisting of primarily didactic sessions, observation and direct patient care. We present our experience with introducing high fidelity, mobile simulation as a method for teaching anesthesia delivery using a new anesthesia machine at two tertiary-care hospitals in Freetown, Sierra Leone. Methods After obtaining IRB approval from the Johns Hopkins School of Medicine and the Ministry of Health and Sanitation, we conducted 100 high-fidelity medical simulations with non-physician anesthetists from seven different hospitals in and near Freetown, Sierra Leone. Educational goals of the training sessions were established based upon a targeted needs assessment from direct observation of over 700 anesthetics performed between April 2012 to January 2013 and upon informal discussions with nurse anesthetists at Connaught Hospital and Princess Christian Maternity Hospital (PCMH). A formal online presentation was developed and utilized for training. After participants viewed the online educational modules, using a mobile simulation system consisting of the IngMar Medical QuickLung® in combination with a RespiTrainer® and the Universal Anaesthesia Machine (UAM), we tested the ability of each participant to perform twelve cognitive/ psychomotor skills (Appendix A) with four scenarios: 1) Light anesthesia/ bronchospasm, 2) Management of anesthesia during a power outage with the UAM, 3) Routine airway management during a failed spinal and 4) A pre-use anesthesia machine check. The scenarios were conducted within the operating theaters at PCMH and Connaught Hospitals. We rated the participant’s ability to perform the twelve tasks on an ordinal scale from 1–5, as well as rating their need for more development/proficiency on a 1–5 scale. Immediate verbal feedback was given on their performance and an opportunity to train to greater proficiency was provided using the simulation platform. The perceived effect of medical simulation in this environment was surveyed before and after each session. Results We observed a total of 25 participants recruited from seven hospitals in and around Freetown. All were non-physician anesthetists, with years of experience performing anesthesia ranging from 0.25 to 6 years (2.5 +/− 1.68) and number of hours per week performing anesthesia ranging from 4 to 64 hours (44.8 +/− 17.2). We observed that more training was needed in almost all of the areas tested, but particularly with preparing the anesthesia machine and identifying hypoxia and bronchospasm (Table 1). Participants surveyed also sensed other areas were needed improvement, namely managing difficult airways and assessing hypoventilation. Conclusion Mobile medical simulation offers a versatile and effective tool for medical training but remains largely underutilized in the developing world. By tailoring our training to situations commonly found in these low resource hospitals (power outages, failed spinal, bronchospasm, etc.), our simulations carried a greater significance and as a result, participant feedback was strongly positive. Average level of comfort for each participant increased significantly with managing an airway, as did the average level of comfort during crisis situations such as bronchospasm and power failure. A common difficulty encountered during our mobile training simulations was power failure during the sessions due to an unreliable power grid to the hospital. We used the QuickLung® ventilator because simulated spontaneous ventilation can be hand-powered and thus used without electricity, allowing for simulation training to continue unimpeded by power outages.