Education In Low- And Middle-income Countries Research Articles

A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries.

Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation. This review provides a framework for conducting outcome evaluation of simulation-based education programmes in low and middle-income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation-based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower-middle-income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed-methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low-resource settings to evaluate their own activities.

Reducing the Gap in Neurosurgical Education in LMICs: A Report of a Non-Profit Educational Program

Central to neurosurgical care, neurosurgical education is particularly needed in low- and middle-income countries (LMICs), where opportunities for neurosurgical training are limited due to social and economic constraints and an inadequate workforce. The present paper aims (1) to evaluate the validity and usability of a cadaver-free hybrid system in the context of LMICs and (2) to report their learning needs and whether the courses meet those needs via a comprehensive survey. From April to November 2021, a non-profit initiative consisting of a series of innovative cadaver-free courses based on virtual and practical training was organized. This project emerged from a collaboration between the Young Neurosurgeons Forum of the World Federation of Neurological Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and UpSurgeOn, an Italian hi-tech company specialized in simulation technologies, creator of the UpSurgeOn Box, a hyper-realistic simulator of cranial approaches fused with augmented reality. Over that period, 11 cadaver-free courses were held in LMICs using remote hands-on Box simulators. One hundred sixty-eight participants completed an online survey after course completion of the course. The anatomical accuracy of simulators was overall rated high by the participant. The simulator provided a challenging but manageable learning curve, and 86% of participants found the Box to be very intuitive to use. When asked if the sequence of mental training (app), hybrid training (Augmented Reality), and manual training (the Box) was an effective method of training to fill the gap between theoretical knowledge and practice on a real patient/cadaver, 83% of participants agreed. Overall, the hands-on activities on the simulators have been satisfactory, as well as the integration between physical and digital simulation. This project demonstrated that a cadaver-free hybrid (virtual/hands-on) training system could potentially participate in accelerating the learning curve of neurosurgical residents, especially in the setting of limited training possibilities such as LMICs, which were only worsened during the COVID-19 pandemic.

Sickle Cell Disease Education in Low and Middle Income Countries Using a Smartphone Clinical Case Discussion App

Introduction Sickle cell disease (SCD) is one of the world's most common hemoglobinopathies, affecting over 400,000 newborns annually (Archer et al., 2022). Despite the World Health Organisation's (WHO) 2006 long-term goals to address the SCD burden, the disease's mortality, particularly within low- and middle-income countries (LMICs) such as India and Sub-Saharan Africa (SSA), remains high (WHO 2006). Barriers to improving outcomes for SCD patients in LMICs include a lack of awareness around treatment guidelines and inadequate clinical knowledge among healthcare professionals (HCPs). While effective medical education programs are essential to the provision of high-quality healthcare services, the delivery of such programs in LMICs is challenging due to limited budgets, poor training infrastructure and equipment, and insufficient educators (Barteit et al., 2020). Recently, consideration has been given to the role that digital learning platforms could play in supporting medical education in LMICs (Nicoll et al., 2018). Aim To assess the impact of a smartphone app delivered medical education program in improving HCP clinical knowledge around SCD in LMICs, focused on SSA (Kenya, Ghana, Zambia, Uganda,Tanzania) and India. Methods The SCD program was developed by subject matter experts with MedShr, a secure app- and web-based clinical case discussion platform freely accessible to HCPs worldwide. The program's focus was determined at the outset through a needs-based approach. Analysis of MedShr's proprietary data enabled the identification of key knowledge gaps among HCPs that could be addressed with case-based education, forming the basis for three themes: 1) Acute SCD presentations 2) Chronic SCD complications 3) Long-term SCD management 9 clinical cases comprising a patient vignette, open question and integrated poll were developed by MedShr in line with the program themes. A case example is displayed in Figure 1. Content delivery via the MedShr platform was from August 2022 to February 2023, during which time the cases were promoted to relevant HCPs via email, push notifications and social media. All content was featured within a SCD Global Education Network group on MedShr, connecting target HCPs and facilitating peer-to-peer discussion. Results During the 6 month program, over 173,000 HCPs were reached globally with the educational content, including 75,070 clinicians in SSA and 64,210 in India. HCPs reached included community health workers (28%), GPs (24%), acute physicians (16%), emergency physicians (32%), pediatricians (13%), hematologists (3%), and nurses (8%). The program achieved over 73,000 engagements (case follows, likes, votes and comments) from target HCPs, including 26,419 engagements from HCPs in SSA and 11,173 from those in India. Stand-alone poll questions aligned to the three educational themes were implemented pre- and post-program delivery to assess the program's educational impact. An improvement in clinician knowledge was demonstrated across all three themes (Figure 2). Participant surveys were also used to determine the program's impact on HCP knowledge and clinical behaviors. 84% of participants deemed the content ‘very valuable’ to their clinical decision-making, while 90% stated that they had implemented knowledge obtained from the program in clinical practice. Conclusions The SCD program delivered via the MedShr smartphone app provided a low-cost, high-impact mechanism to deliver effective medical education in LMICs. MedShr's unique SCD professional network provides a digital interface for HCPs, through which peer engagement, interactive discussion and sharing feedback drive learning and behavioral change. The program's metrics highlight the potential scale for digital learning platforms to reach and engage HCPs across diverse geographies, and the program polling and participant surveys demonstrate impact, and that there is scope to improve HCPs' knowledge and practice without costly face-to-face education. Future work should aim to develop tailored learning programs designed to fit local contexts in LMICs, and explore the use of technology-based learning programs in other commonly encountered disease areas. The educational program was funded by an unrestricted educational grant from Novartis. Novartis had no input into content development and their employees could not access the MedShr platform or members.

Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review.

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.

Psychometric Properties and Assessment of Knowledge, Attitude, and Practice Towards ChatGPT in Pharmacy Practice and Education: a Study Protocol.

ChatGPT represents an advanced conversational artificial intelligence (AI), providing a powerful tool for generating human-like responses that could change pharmacy prospects. This protocol aims to describe the development, validation, and utilization of a tool to assess the knowledge, attitude, and practice towards ChatGPT (KAP-C) in pharmacy practice and education. The development and validation process of the KAP-C tool will include a comprehensive literature search to identify relevant constructs, content validation by a panel of experts for items relevancy using content validity index (CVI) and face validation by sample participants for items clarity using face validity index (FVI), readability and difficulty index using theFlesch-Kincaid Readability Test, Gunning Fog Index, or Simple Measure of Gobbledygook (SMOG), assessment of reliability using internal consistency (Cronbach's alpha), and exploratory factor analysis (EFA) to determine the underlying factor structures (eigenvalues, scree plot analysis, factor loadings, and varimax). The second phase will utilizethe validated KAP-C tool to conduct KAPsurveysamong pharmacists and pharmacy students in selected low- and middle-income countries (LMICs) (Nigeria, Pakistan, and Yemen). The final data will be analyzed descriptively using frequencies, percentages, mean (standard deviation) or median (interquartile range), and inferential statistics like Chi-square or regressionanalyses using IBM SPSS version 28. Ap<0.05 will be considered statistically significant.ChatGPT holds the potential to revolutionize pharmacy practice and education. This study will highlight the psychometric properties of the KAP-C tool that assesses the knowledge, attitude, and practice towards ChatGPT in pharmacy practice and education. The findings will contribute to the potential ethical integration of ChatGPT into pharmacy practice and educationin LMICs, serveasa reference to other economies, and provide valuable evidence for leveraging AI advancements in pharmacy.

Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review

Background Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low- and middle-income countries (LMICs). Objective This study aims to determine which types of surgical simulation tools have been most widely used in LMICs, how surgical simulation technology is being implemented, and what the outcomes of these efforts have been. We also offer recommendations for the future development of digital surgical simulation implementation in LMICs. Methods We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. Eligible papers involved surgical trainees or practitioners who were based in LMICs. Papers that include allied health care professionals involved in task sharing were excluded. We focused specifically on digital surgical innovations and excluded flipped classroom models and 3D models. Implementation outcome had to be reported according to Proctor’s taxonomy. Results This scoping review examined the outcomes of digital surgical simulation implementation in LMICs for 7 papers. The majority of participants were medical students and residents who were identified as male. Participants rated surgical simulators and telecommunications devices highly for acceptability and usefulness, and they believed that the simulators increased their anatomical and procedural knowledge. However, limitations such as image distortion, excessive light exposure, and video stream latency were frequently reported. Depending on the product, the implementation cost varied between US $25 and US $6990. Penetration and sustainability are understudied implementation outcomes, as all papers lacked long-term monitoring of the digital surgical simulations. Most authors are from high-income countries, suggesting that innovations are being proposed without a clear understanding of how they can be incorporated into surgeons’ practical training. Overall, the study indicates that digital surgical simulation is a promising tool for medical education in LMICs; however, additional research is required to address some of the limitations in order to achieve successful implementation, unless scaling efforts prove futile. Conclusions This study indicates that digital surgical simulation is a promising tool for medical education in LMICs, but further research is necessary to address some of the limitations and ensure successful implementation. We urge more consistent reporting and understanding of implementation of science approaches in the development of digital surgical tools, as this is the critical factor that will determine whether we are able to meet the 2030 goals for surgical training in LMICs. Sustainability of implemented digital surgical tools is a pain point that must be focused on if we are to deliver digital surgical simulation tools to the populations that demand them the most.

Exploring Irish Faculty Members' Experiences of Delivering a Multi-modal Medical Education Course in a Resource-limited Environment

Introduction:In November 2022, a group of eleven Irish doctors traveled to St. Joseph’s Hospital, Nyabondo, Kenya with Global Emergency Care Skills (GECS), an Irish NGO. The group delivered a training course to healthcare staff in the hospital, in advance of the scheduled opening of a regional Major Trauma Center on site. This course incorporated didactic lectures, skills stations and simulated clinical scenarios and covered commonly encountered emergency presentations in low and middle income countries (LMICs).Method:A qualitative study was conducted using a free text questionnaire with faculty, exploring their experiences of education in a resource-limited environment. Responses were interpreted by performing thematic analysis to identify recurring themes.Results:All eleven faculty members completed the survey in full. An interrogation of the responses identified commonalities across the majority of faculty members. The main themes encountered were increased recognition of the lack of postgraduate training in LMICs, the challenge of devising material appropriate to a resource-limited setting, a growth in confidence and individual teaching ability, and a reaffirmation of the effectiveness of simulation teaching in medical education.Conclusion:This survey demonstrates the significant impact of teaching such a course on faculty members. Despite the challenges encountered, faculty members strongly felt that simulation training offered significant benefits. Survey respondents noted that moulage could be adapted to suit the needs of course participants without compromising on educational goals. In the absence of formal postgraduate education in LMICs, external agencies continue to play an important role in the delivery of structured training programs.

862: FEASIBILITY TRIAL OF ADAPTIVE ELECTRONIC LEARNING FOR PEDIATRIC HEALTHCARE WORKERS IN TANZANIA

Introduction: Gaps in provider education contribute to millions of pediatric deaths in low- and middle-income countries (LMICs). Conventional education in LMICs is limited by reach, sustainability, and inability to scale. Adaptive electronic learning (AEL) is superior to conventional education in high-income countries and may overcome existing barriers in LMICs. In order to address the existing limitations of current provider education in LMICs, we developed an AEL curriculum based on evidence-based guidelines for the management of acutely-ill children. We undertook a feasibility trial of this curriculum among a cohort of medical interns at a tertiary referral hospital in Tanzania. Methods: We developed and tested our 11-module curriculum in a convenience sample of clinical interns at a zonal academic hospital in Mwanza, Tanzania. Following enrollment, participants accessed PACE for up to 10 weeks. RE-AIM is an established framework to assist in translating research into implementation. Using 3 of RE-AIM’s 5 evaluative dimensions, we defined feasibility as > 15% mean knowledge increase (efficacy), > 75% providers initiating PACE (adoption), and > 60% completing all modules (maintenance). These percentages reflect thresholds found in similar educational interventions. Results: 21 clinical interns participated. Overall efficacy was 24% (95% CI 3.06, 45.74), adoption was 81% (17/21) and maintenance was 33% (7/21). No differences in demographics, job satisfaction, motivation, or data usage were detected between those who completed maintenance and those who did not. Sixty-five percent (13/20) had previous conventional pediatric training and twenty percent (5/20) used electronic media as a primary learning source for continuing medical education. For those who maintained PACE, median number of learning episodes was 9 and time to completion was 181 minutes. Nine of eleven modules required < 30 minutes to complete. Conclusions: In its current implementation strategy, PACE was feasible for efficacy and adoption, but not maintenance. Our cohort reported high levels of previous training, but low use of electronic media as a learning source. Provider usage characteristics suggest that module size and content were appropriate for this cohort. Refinement of our implementation strategy is needed to increase maintenance.

Global disparities in arrhythmia care: Mind the gap.

Delivery of comprehensive arrhythmia care requires the simultaneous presence of many resources. These include complex hospital infrastructure, expensive implantable equipment, and expert personnel. In many low- and middle-income countries (LMICs), at least 1 of these components is often missing, resulting in a gap between the demand for arrhythmia care and the capacity to supply care. In addition to this treatment gap, there exists a training gap, as many clinicians in LMICs have limited access to formal training in cardiac electrophysiology. Given the progressive increase in the burden of cardiovascular diseases in LMICs, these patient care and clinical training gaps will widen unless further actions are taken to build capacity. Several strategies for building arrhythmia care capacity in LMICs have been described. Medical missions can provide donations of both equipment and clinical expertise but are only intermittently present and therefore are not optimized to provide the longitudinal support needed to create self-sustaining infrastructure. Use of donated or reprocessed equipment (eg, cardiac implantable electronic devices) can reduce procedural costs but does not address the need for infrastructure, including diagnostics and expert personnel. Collaborative efforts involving multiple stakeholders (eg, professional organizations, government agencies, hospitals, and educational institutions) have the potential to provide longitudinal support of both patient care and clinician education in LMICs.

Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

The recent emphasis on surgery as an essential yet neglected component of global health care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for children, leaving few access to care for readily treatable conditions, like pediatric hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to improve hydrocephalus management and medical education in LMICs. A literature search on global pediatric neurosurgery was performed using the Pubmed database from the year 2000 to October 5th, 2021. The majority of current pediatric neurosurgical efforts focus on the management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) has emerged as an effective alternative to ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in LMICs are most successful when twinning is used to pair the program with an established center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next step in developing sustainable surgery programs in LMICs includes establishing local training programs. Existing global pediatric neurosurgery programs are most successful when partnered to an experienced center in a HIC. A lack of funding, resources, and training programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future global neurosurgery efforts may look to other neurosurgical conditions with high burdens of disease in LMICs, like epilepsy.

Feasibility of multimedia animations as preoperative guides for urgent abdominal surgeries in a public hospital in Brazil.

Health literacy, culture and language play vital roles in patients' understanding of health issues. Obstacles are more evident in low- and middle-income countries (LMICs), where inadequate patient education levels are higher and hospital resources are lower. This is a prospective pilot study assessing the feasibility of digital preoperative animations as guides for surgical patients. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Thirty-four patients were included, and 26 patients concluded the intervention (76.5% acceptability rate). Demographic factors seemed to affect the results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. Few studies have evaluated the use of multimedia resources for surgical patients, and no studies assessed the use of animations as digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based approach is proposed to aid the implementation of patient education digital interventions. The use of digital multimedia animations as preoperative guides in LMICs is feasible. It may help improve patient education and promote clinical benefits.

Decolonizing Global Surgery: Bethune Round Table, 2022 Conference on Global Surgery (virtual), June 16-18, 2022.

# Overcoming barriers to pediatric trauma education in low-and middle-income countries {#article-title-2} Trauma remains a leading cause of child mortality and disability worldwide, taking the lives of 1 million children annually. Of all deaths from pediatric trauma, 95% occur in low- and middle-

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis.

BackgroundSchool feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs.MethodsInterventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible.ResultsFifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001).ConclusionsSchool feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement.RegistrationPROSPERO ID: CRD42020159003.

Patients' knowledge of diabetes foot complications and self-management practices in Ghana: A phenomenological study.

BackgroundThe prevalence of diabetes is increasing in low and middle-income countries (LMICs) and over two-thirds of these are not diagnosed. Consequently, diabetes complications usually exist at the time of diagnosis. Foot ulcers is a leading cause of disability and mortality among diabetes patients.PurposeTo assess the knowledge and experiences of adult patients with Diabetes on diabetes complications and self-management practices with emphasis on foot care.MethodologyThis applied phenomenological study design. Twenty patients attending Diabetes clinics were purposively sampled from two hospitals in Ghana. Face-to-face semi-structured interviews were conducted to evaluate patient’s understanding of diabetes and self-management practices. The interviews were audio-taped, transcribed, and analysed to generate themes using the constant comparison method.ResultsThree-quarters of the participants in the study correctly defined diabetes as high blood glucose levels, but few knew the risk factors and complications of diabetes. Stroke and Hypertension were the most popular complications known, whiles diabetes foot complications were the least known. Almost all participants showed awareness of dietary self-management practices, but few had limited knowledge in foot care practices.ConclusionDiabetes education in LMICs should promote self-management practices, especially foot care and clear dietary guidelines. There is also opportunity to invest in specialist diabetes training for healthcare providers and increase community-based care for people living with diabetes in Ghana.

Feasibility of Online Multimedia Animations as Preoperative Guides for Urgent Abdominal Surgeries in a Public Hospital in Brazil

Introduction: Preoperative education helps patients feel less anxious and improve self-care while decreasing hospitalization time and demand for postoperative analgesia. Health literacy, culture and language play vital roles in patients’ understanding of health issues and may influence treatment outcomes. Obstacles are more evident in low- and middle-income countries (LMICs), where inadequate patient education levels are higher and hospital resources lower. Methodology: A prospective pilot study assessing the feasibility of online preoperative multimedia animations as guides for surgical patients in an LMIC was performed. They are in the local language with a holistic focus on surgical patient education. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Results: Thirty-four patients were included in the study. Twenty-six patients concluded the intervention (acceptability rate of 76.5%). Demographic factors seemed to affect results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. No issues were reported regarding integration to local protocols. Discussion: Few studies have evaluated use of multimedia resources for preoperative patients. No studies assessed the use of animations and none analyzed digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based protocol approach is proposed by this study to aid the implementation of patient education digital interventions. Conclusion: The use of online multimedia animations in local language as preoperative guides in LMICs is feasible. It may help improve patient education in these contexts and promote beneficial clinical outcomes for surgical patients. This positive feasibility study opens the way for future randomized trials to assess the tool’s clinical impacts. Funding: None to declare. Declaration of Interest: Gabriel Schnitman is an intern for Mitacs Accelerate program. No other conflicts of interest to declare. Ethical Approval: This study was approved by the Institutional Review Board at McGill University in Canada and in the Research Ethics Board in the University of Sao Paulo (USP) in Brazil, where certificates of ethical approval were obtained.

Changing the Landscape of Obstetric Resident Education in LMIC Using Simulation Based Training [37G

INTRODUCTION: Maternal mortality continues to be one of the largest health burdens in reproductive-aged women in low- and middle-income countries (LMIC). Simulation-based training (SBT) has been previously piloted demonstrating that SBT was an accepted method of teaching skills for managing high-risk labor in LMIC. METHODS: An in-country simulation based education course on the management of post-partum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) were provided to three major governmental teaching hospitals in Guatemala City, Guatemala. Participants were 46 OB/GYN residents. A paired Student t-test was conducted to compare clinical knowledge regarding these obstetric emergencies at three timepoints: before SBT, one week, and six months after SBT. RESULTS: There was significant increase in scores in clinical knowledge of SD and MCA one week (M=7.83, SD=1.1) following SBT compared to baseline (M=5.96, SD=1.75); P≤.05. However, for PPH there was no increase in scores one-week (M=2.91, SD=0.94) following SBT compared to baseline (M=2.73, SD 0.65); P&gt;.05. Additionally, the difference in scores was maintained at six months following SBT for SD and MCA (M=7.52, SD=1.09) compared to baseline (M=5.96, SD=1.75); P≤.05. PPH scores at six-months (M=3.36, SD 0.65) showed a significant increase compared to baseline (M=2.73, SD=0.65); P≤.05. CONCLUSION: Simulation-based training was found to be an effective method to increase cognitive clinical knowledge in LMIC for rarely seen events of MCA and SD but not with the more common event of PPH. This knowledge increase was maintained six-months after participation in the training.

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: protocol for a systematic review and meta-analysis

BackgroundSchool feeding programs are beneficial for the physical, mental, and psychosocial development of school-age children and adolescents, particularly those in low- and middle-income countries (LMICs). While school feeding programs are ubiquitous in LMICs, the specific benefits of school feeding programs are unclear. The aim of this systematic review and meta-analysis is to evaluate the impacts of school feeding programs on the educational and health outcomes of children and adolescents in LMICs.MethodsRigorously designed interventional studies on the impacts of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs will be included. The following information sources were used to identify relevant published or unpublished studies: MEDLINE, EMBASE, CINAHL, the Cochrane Library, and governmental or organizational websites. The risk of bias of randomized and non-randomized studies will be assessed using the Cochrane Risk of Bias tool and the ROBINS-I tool, respectively. Two reviewers will independently conduct the selection of studies, data extraction, and assessment of the risk of bias. A narrative synthesis of all the included studies will be provided. Meta-analyses will be performed whenever appropriate. Heterogeneity of effects will be assessed by I2, subgroup analyses, and meta-regression. The certainty of evidence for each outcome will be assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.DiscussionThe design and implementation of school feeding programs in LMICs should be based on the understanding of the benefits of such programs. This work will provide a crucial evidence base for the educational and health benefits of school feeding on children and adolescents in LMICs.Systematic review registrationThis protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on November 18, 2019 (registration number: pending).

Continued nursing education in low-income and middle-income countries: a narrative synthesis

IntroductionContinued nursing education and development can reduce mortality and morbidity of patients and can alleviate the shortage of healthcare workers by training of nurses for high-demand skill sets. We reviewed...

An International Collaborative Study on Surgical Education for Quality Improvement (ASSURED): A Project by the 2017 International Society of Surgery (ISS/SIC) Travel Scholars International Working Group.

There is a huge difference in the standard of surgical training in different countries around the world. The disparity is more obvious in the various models of surgical training in low- and middle-income countries (LMICs) compared to high-income countries. Although the global training model of surgeons is evolving from an apprenticeship model to a competency-based model with additional training using simulation, the training of surgeons in LMICs still lacks a standard pathway of training. This is a qualitative, descriptive, and collaborative study conducted in six LMICs across Asia, Africa, and South America. The data were collected on the status of surgical education in these countries as per the guidelines designed for the ASSURED project along with plans for quality improvement in surgical education in these countries. The training model in these selected LMICs appears to be a hybrid of the standard models of surgical training. The training models were tailored to the country's need, but many fail to meet international standards. There are many areas identified that can be addressed in order to improve the quality of surgical education in these countries. Many areas need to be improved for a better quality of surgical training in LMICs. There is a need of financial, technical, and research support for the improvement in these models of surgical education in LMICs.

Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review

In low- and middle-income countries (LMICs), e-learning for medical education may alleviate the burden of severe health worker shortages and deliver affordable access to high quality medical education. However, diverse challenges in infrastructure and adoption are encountered when implementing e-learning within medical education in particular. Understanding what constitutes successful e-learning is an important first step for determining its effectiveness. The objective of this study was to systematically review e-learning interventions for medical education in LMICs, focusing on their evaluation and assessment methods.Nine databases were searched for publications from January 2007 to June 2017. We included 52 studies with a total of 12,294 participants. Most e-learning interventions were pilot studies (73%), which mainly employed summative assessments of study participants (83%) and evaluated the e-learning intervention with questionnaires (45%). Study designs, evaluation and assessment methods showed considerable variation, as did the study quality, evaluation periods, outcome and effectiveness measures. Included studies mainly utilized subjective measures and custom-built evaluation frameworks, which resulted in both low comparability and poor validity. The majority of studies self-concluded that they had had an effective e-learning intervention, thus indicating potential benefits of e-learning for LMICs. However, MERSQI and NOS ratings revealed the low quality of the studies' evidence for comparability, evaluation instrument validity, study outcomes and participant blinding. Many e-learning interventions were small-scale and conducted as short-termed pilots. More rigorous evaluation methods for e-learning implementations in LMICs are needed to understand the strengths and shortcomings of e-learning for medical education in low-resource contexts. Valid and reliable evaluations are the foundation to guide and improve e-learning interventions, increase their sustainability, alleviate shortages in health care workers and improve the quality of medical care in LMICs.