Local Trainers Research Articles

How to … navigate specialised programmes for early-career doctors in medical education.

Investing in early-career medical education programmes for aspiring clinician-educators, scholars and leaders offers a strategic approach to shaping the future of health professions education internationally. This paper explores the design and impact of a nationally funded Specialised Foundation Programme (SFP) within the United Kingdom. Drawing on existing literature and insights from local trainees, we provide practical guidance for early-career doctors navigating entry into the field of health professions education. Additionally, we discuss the programme's potential to enhance professional development through structured mentorship, formal qualifications and active participation in scholarly activities, while also addressing the challenges inherent in navigating clinical and academic identities. This paper will be valuable to doctors embarking on early-career medical education pathways, programme leaders and international stakeholders seeking to establish similar initiatives to support the next generation of health care educators and scholars.

Fifteen years of training courses and implementation of child and adolescent psychiatry in Jimma, South-West Ethiopia: a single site case study

In Ethiopia, as in many other low-and middle-income countries, health professionals, particularly mental health workers, are scarce. The purpose of this case study is to describe the process of establishing training child psychiatry and capacity building to implement clinical care for child and adolescent mental health. We present a case study on training of child and adolescent psychiatry embedded within the master’s degree program in integrated clinical and community mental health at the department of psychiatry in Jimma University, Ethiopia. This program is jointly developed in collaboration between Jimma University and Ludwig-Maximilian-University, Germany. The core elements of the training were to train mental state description, making decisions on possible disorders, perform occupational activities, and design psychosocial interventions. The WHOmhGAP guide is considered as appropriate knowledgebase for our teaching program. Each course was evaluated bidirectional with multiple methods. From 2010 to 2024, twelve trainings were organized. We structured the program in three phases. The initial phase (2010–2014) was to establish collaboration with guest lecturers and to develop, implement, and evaluate the training. The second phase (2015–2019) changed to mentorship and transition from guest lecturers to local trainers and included a refresher course. Phase three (2020–2024) was independent work. An outpatient clinical service for children was implemented by the lead author and now is running at Jimma University. The implementation of the training took place in small steps. A long-term commitment of local and guest lecturers enabled to develop culturally appropriate solutions for the local context. A similar approach can be applied to effectively start and expand child and adolescent mental health care in other resource limited settings.

Building sustainable local training capacity for maternal and newborn health within the public health system: A training intervention in Palghar District, India

Continuing professional development for the health workforce is of paramount importance and can be implemented using locally available, competent trainers. However, guidelines for the selection, development, and mentorship of such trainers are lacking. Training intervention research conducted in Western Maharashtra, India, aimed to address these gaps by focusing on skills for maternal and newborn health (MNH). In this study, selected trainers from a pilot project in the Pune district received advanced training to become core trainers (CTs) for a scale-up project in Palghar district (2019 – 2022). The CTs trained master trainers (MTs) in Palghar (n = 32) with support from the United Kingdom-based technical partners, following a six-step approach: selection of trainers, training of trainers (ToT) (including knowledge and skills assessment), staggered induction as trainers, continuous support, regular quality assessment, and virtual refresher training. The process and outcomes of this six-step approach were evaluated using mixed-methods research. The skills of local trainers were augmented through hands-on training and further supported by long-term mentorship to develop training excellence. The CTs’ competency as mentors improved due to appreciative feedback. Regular assessments conducted by the expert team also contributed to maintaining quality control. Online learning has emerged as an effective method for refresher training. There was considerable improvement in the clinical knowledge and skills of the health providers from Palghar (n = 505), which attests to the quality of the training delivered by the Palghar MTs. This intervention enhanced both clinical competency and confidence. The approach demonstrated the importance of recruiting suitable participants who could consciously shift their teaching style to become more adult-learner-centric facilitators. However, there is a need for a systematic, long-term evaluation of this model, its application to MNH care, and its institutionalization within the public health system.

Role of e-learning for the continuing professional development of university librarians of Pakistan to deliver value-added services: an explanatory study

Purpose This study aims to identify the role of e-learning for the continuing professional development (CPD) of university librarians in Pakistan to deliver value-added library services. Design/methodology/approach Explanatory sequential design was applied to address this study’s objectives. First, quantitative data were gathered from 341 respondents working in 244 universities and then qualitative data were gathered through an interview guide from 27 subjects working in different university libraries of Pakistan. Findings The findings of this study revealed that respondents realized the benefits of e-learning for continuing professional development positively. E-learning enabled university librarians to perform IT-based tasks through an adequate usage of digital technologies. The findings also manifested that the majority of the respondents faced the challenges of the lack of technical support, and inadequate organizational support to adopt e-learning for CPD. Results displayed e-learning courses should be conducted by local trainers. Originality/value This study has provided pertinent theoretical, practical and social contributions by identifying the role of e-learning for the CPD of university librarians of Pakistan to deliver value-added services.

Evaluation of an On-Site Disaster Medical Management Course in Nepal.

The great 2015 Nepal earthquake of magnitude 7.6 killed about 9000 people. To better ensure a more coordinated disaster response, a Basic On-Site Disaster Medical Support (BOS-DMS) course was designed in 2017. This study evaluates the effectiveness of the BOS-DM course. The course was conducted twice and attended by 135 participants, of whom 113 (83.7%) answered pre-test and post-test based multiple-choice questions. Qualitative and quantitative feedback was provided by 94 participants (69.6%). Mean test scores for the participants increased from 4.24 ± 1.42 to 6.55 ± 2.16 (p-value < 0.0001; paired t-test). More than 92.0% of participants felt that the course prepared healthcare workers to manage acute medical situations at a disaster site. Subject knowledge scores increased from 34.8% to 90.2%. A three-day BOS_DMS course has the potential to improve on-site disaster management knowledge. Our study noted that precise scheduling, making attendance compulsory, translating course materials into the local language, inclusion of disaster exercises and training local master trainers can enhance course effectiveness.

TRAINING PROCEDURE OF VOCAL MIMICRY BIRD, COMMON MYNA (ACRIDOTHERES TRISTIS) BY LOCAL TRAINERS IN KELANTAN, MALAYSIA

Acridotheres tristis, or common myna or Indian myna is a bird species that can mimic human words and sounds around them. Local trainers used to teach the common myna in the State of Kelantan to mimic the words taught using several training procedures. This study aims to determine whether the training procedures used by local trainers have helped in the training process, and the factors that affect the mimicry process for this species are also highlighted. Interview sessions were conducted in nine districts in the State of Kelantan to collect data from local trainers from November 2021 until May 2022. This study utilised the Kruskal-Wallis test to analyse the significant difference in training time among different training procedures and different types of food and water for common myna. The results indicated that the training procedures used by local trainers have affected the training time of this species (p ≤ 0.05). The mean value of training time for other scrape techniques is the lowest, which is considered the best training method in training common myna to mimic the words. The second highest mean value is none scraping methods, followed by scraping tongue using Lalang, which has the highest mean value. In addition, the types of food and water given to common myna by the local trainers during the training procedure did not show a significant difference in training time. Keywords: Mimic, Acridotheres tristis, common myna, training procedure, local trainer. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Design and pilot of an inclusive environmental education course for a community living under the unprecedented environmental emergencies in Pakistan- a case study

ABSTRACT This study presents the design and pilot of the environmental education course with one of the communities, living under environmental emergencies in Pakistan. The study employs the case study as a research approach. Community-based participatory research is used as a method. Forty participants are selected from one of the communities in Hunza, Gilgit-Baltistan, Pakistan. First, I gathered pre-intervention data through an online survey followed by focus group discussions. Next, together with participants, I designed and piloted a contextual environmental education course. Finally, I collected post-intervention data through an online survey and conducted focus group discussions. Data is analyzed using line graphs and narrative analysis. The course enhanced participants’ environmental literacy and equipped them with relevant strategies and contextual skills pertinent to supporting their communities during environmental catastrophes. Peace-building approaches, such as collaborative problem-solving case studies and development of conflict management skills, specifically enabled participants to understand the complexities of challenges and propose innovative solutions. Participants suggested the inclusion of models and standards of environmental education, and research components in the future course. They further recommended translating the course into a regional language, preparing local trainers, and introducing the same course via face-to-face mode to the illiterate population within their communities.

The impact of a blended multidisciplinary training for the management of obstetric haemorrhage in Mbeya, Tanzania.

The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers' (HCPs') competencies has been the key attribute. This study measured the impact on HCP's competencies from a blended training programme on obstetric haemorrhage. A "before and after" cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use. There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (-0.009 -0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (-0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (-0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (-0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05-0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training. This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.

B - 27 Philadelphia Neuropsychology Society's Equity Forum: Efforts to Address Local Level Needs for Equity in Neuropsychology.

While there are growing national advocacy efforts to advance equity in neuropsychology, fewer initiatives exist at local and regional levels. The Philadelphia Neuropsychology Society's (PNS) Equity Forum was created to provide diversity, equity, and inclusion (DEI)-related support, advocacy, and resources to local trainees, professionals, and communities. We describe the Forum's efforts to promote policies, educate, and offer support at a local level. We conducted an archival review of activities of the PNS Equity Forum from January 2021 to April 2023, including a PNS needs assessment survey (NAS), the southeastern PA Regional Community Health Needs Assessment (rCHNA), electronic correspondence, and website traffic. Results identified the need to increase access to resources for 1) culturally responsive research, 2) bilingual providers, 3) low-cost care, and 4) brain health education for the local public. In response, the Forum implemented the following initiatives: monthly ce seminars and journal club, quarterly newsletter, and a resource repository for culturally, linguistically, and socioeconomically diverse communities in the Philadelphia region. The Forum provided DEI-related education to monthly PNS speakers and created safe discussion spaces after national tragedies. The PNS Forum website page saw a 114% increase in views, the list of bilingual and culturally-aware providers received 25% more views, and the quarterly newsletter saw a 100% increase in views in the last month. Neuropsychologists can serve as social change agents in local and regional neuropsychology organizations, and create transformational spaces for accessible, equitable, and sustainable neuropsychology practices and training environments.

Preparation of Soft Embalmed Cadavers by the Modified Thiel Embalming Technique for Surgical Skill Training and Development of a Universal Quantitative Scoring System to Assess the Suitability of Soft Embalmed Cadavers for Such Training Purposes.

Background Cadaver dissection plays an important role in learning anatomy. A surgeon must have a thorough knowledge of anatomy of the operating region to perform safe surgery. Skill laboratories give opportunities to surgeons to practice on cadavers before venturing onto real patients. The most common method of cadaver preservation is through formalin fixation. In the process of fixation, formalin destroys the tissue characteristics and also has issues such as smell, eye irritation, hardening of tissue, and risk of carcinogenesis. The Thiel embalming technique and its modifications were developed to address those issues. Our primary objective was to find the benefits of soft embalmed cadavers over formalin-fixed bodies and, secondly, to find out microbial flora in soft embalmed cadavers. Study design This is a basic study. Methods Four cadavers were prepared for the soft embalming purpose for our workshop for surgeons on spine fixation. Due to unavailability, we replaced 4-chloro-3-methylphenol 1% with phenol 1%. The bodies were preserved in refrigerators at 4°C before being used for the workshop purpose. The delegates and faculties were given a questionnaire to assess their experience of the cadavers in terms of odor, irritation, tissue characteristics, joint mobility, and imaging characteristics. The results were calculated using statistical analysis. Swabs were taken from a few of the cadavers for culture to find the organisms. Results There were 14 questions in the questionnaire, and the data collected were divided into two groups, faculties, and delegates. JASP software was used to analyze the data. The questions addressed various aspects of cadavers such as color, odor, tissue pliability, joint flexibility, imaging characteristics, mucosal irritation, and earlier experience in working with cadavers. Cronbach α was used to find the correlation between the various characteristics analyzed. The authors intend to name the domains being measured: surgical suitability (scores of items 8 to 12), imaging suitability (scores of items 5 and 6), and smell score (scores of items 5 and 6). It can be a guide to constructing and refining a better quantitative scale to measure the "quality of soft-embalmed cadavers for surgical training." Conclusions Skill laboratories give opportunities to young surgeons and trainees to learn and improve their skills before applying them to real patients. This was our first attempt to develop soft embalmed cadavers at our center and our state. We used the parent solution with some variations as per the availability of chemicals at our place and found that the features of the preserved cadavers were good and well-suited to address our purpose. Therefore, with some variations in the parent formulations, centers situated in remote and less developed places can formulate their own solution to develop soft embalmed cadavers and establish cadaver skill laboratories. This will benefit the local surgeons and trainees. The authors tried to develop a few domains through statistical analysis, which can be used to assess and compare the quality of cadavers prepared at various centers.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial using train-the-trainer

BackgroundTrain-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction—the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)—delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers’ perceptions of fit.MethodsTTT will be implemented in nine CMHCs in California, USA (N = 60 providers; N = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers’ perceptions of fit. Aim 3 will evaluate whether Generation 2 providers’ perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators.DiscussionThis trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers’ perceptions of EBPT “fit” across TTT generations.Trial registrationClinicalTrials.gov identifier NCT05805657. Registered on April 10, 2023.

Train-the-Trainers in hand hygiene facilitate the implementation of the WHO hand hygiene multimodal improvement strategy in Japan: evidence for the role of local trainers, adaptation, and sustainability

Background“Train-the-Trainers in hand hygiene” (TTT) is a standardized training to train infection prevention and control (IPC) practitioners with the aim to promote hand hygiene in health care according to the World Health Organization (WHO) multimodal improvement strategy. Little is known in the literature about the sustained impact of hand hygiene and IPC trainings adapted locally. The aim of this study is to describe the impact of three TTT courses conducted annually in Japan on the adoption of the WHO multimodal improvement strategy by local IPC practitioners who became a “trainer” after their first TTT participation as a “trainee”.MethodsThree TTT courses were conducted annually from 2020 to 2022 in Japan. A team “TTT-Japan” composed of more than 20 IPC practitioners who completed their first TTT participation adapted the original TTT program to reflect the local healthcare context in Japan, and subsequently convened the 2nd and 3rd TTTs. Pre- and post-course evaluations and post-course satisfaction surveys of the course participants were conducted to assess improvement in knowledge on hand hygiene and perception towards the course, respectively. Attitude and practice surveys of the TTT-Japan trainers were conducted to assess their perception and experience in hand hygiene promotion. The Hand Hygiene Self-Assessment Framework (HHSAF), a validated tool created by WHO to monitor the capacity of hand hygiene promotion at facility level, was applied at TTT-Japan trainers’ facilities to compare results before and after trainers’ engagement. We applied inductive thematic analysis for qualitative analyses of open-ended survey questions of the trainers’ attitude and practice surveys, and the Wilcoxon Sign Rank test for quantitive comparisons of pre- and post-data for the surveys and HHSAF.Results158 Japanese healthcare workers participated in three TTT courses, the majority of whom (131, 82.9%) were nurses. Twenty-seven local trainers were involved in 2nd and 3rd TTTs. The scores of pre- and post-course evaluations significantly improved after the course (P < 0.001) and the improvement was consistent across all three TTTs. Post-course satisfaction survey showed that over 90% of the participants reported that the course met their expectations and that what they learned in the courses would be useful for their practice. Trainers’ attitude and practice survey showed that more than three quarters (76.9%) of the trainers reported that their experience as a trainer had a positive impact on their practice at their own facilities. Qualitative analysis of the trainers’ attitude and practice survey revealed that trainers appreciated continuous learning as a trainer, and group effort to promote hand hygiene as the TTT-Japan team. The HHSAF institutional climate change element at the trainers’ facilities significantly improved after their engagement as a trainer (P = 0.012).ConclusionsTTTs were successfully adapted and implemented in Japan, leading to sustained hand hygiene promotion activities by local trainers over three years. Further research is warranted to assess the long-term impact on local hand hygiene promotion in different settings.

Cross-sectional study in Madagascar demonstrates efficacy of virtual mentoring and flipped classroom modifications of neonatal resuscitation programme Helping Babies Breathe.

The Covid-19 pandemic necessitated virtual adaptation of the neonatal resuscitation programme Helping Babies Breathe (HBB). This study assessed one such virtually mentored and flipped classroom modification in Madagascar. A cross-sectional study was performed in September 2021 and May 2022. Healthcare providers were identified by local collaborating organisations. United States-based master trainers collaborated with local trainers on virtually mentored trainings followed by independent trainings. Master trainers were available for consultation via Zoom during the virtual training. A flipped classroom modification and traditional didactic method were compared. Primary outcomes were knowledge and skill acquisition, evaluated by written assessments and objective structured clinical examinations. Overall, 97 providers completed the curriculum. Written assessment scores improved in both training models (traditional-74.8% vs 91.5%, p < 0.001; flipped classroom-89.7% vs 93.6%, p < 0.05). There was no significant difference among written assessment scores (92.8% vs 91.5%, p = 0.62) and significantly higher objective structured clinical examination scores (97.3% vs 89.5%, p < 0.001) for the independent training compared to the virtually mentored training. The virtually mentored HBB training was followed by a successful independent training as measured by participant knowledge and skill acquisition, supporting the efficacy of virtual dissemination.

Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training Package Developed for the National Emergency Medical Service in Sierra Leone

Introduction:In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.Method:The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.Results:Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.Conclusion:The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.

Evaluating the Experience of Visiting International Providers on Local Neurology Trainees in a Resource-Limited Setting (P4-8.007)

<h3>Objective:</h3> Assess the impact of visiting international neurology attendings and trainees on local neurology trainees in Zambia. <h3>Background:</h3> Interest in global neurology is increasing among U.S. neurology residents. Global health electives improve clinical skills, commitment to underserved populations, and cost-effective decision-making practices among neurology trainees from high-income settings. However, existing literature focuses primarily on the experiences of Canadian and U.S. trainees, with formal research on the perspective of local neurology trainees lacking. <h3>Design/Methods:</h3> The Zambian neurology training program, which graduated its first class in 2018, frequently hosts visiting neurology attendings and residents from high-income settings. Current trainees and graduates of the program completed surveys and participated in focus groups to assess their experiences with visitors and the impact on their training. <h3>Results:</h3> 100% of current trainees (n=5) and program graduates (n=4) participated. All participants rated the experience of working with international visitors positively (56% rated 5/5 (most positive), 44% rated 4/5). Specific positive aspects included exposure to different teaching styles and clinical approaches, awareness of neurologic practice in different parts of the world, expertise in subspecialties less available locally, and expanded academic networking opportunities. Local trainees appreciated the clinical contribution to busy inpatient and outpatient services, the ability to compare themselves to an “international standard”, and the cultural exchange with visitors. Challenges of working with visitors included occasional discrepancies in expectations, prolonged patient encounters due to language barriers, incomplete understanding by visitors of cultural differences and resource limitations, and physical workspace constraints. <h3>Conclusions:</h3> Local trainees in Zambia reported an overall positive experience with visiting providers from high-income countries. Our results provide support for expanding global health electives and faculty opportunities in Zambia and, potentially, similar settings. Orientation sessions for visiting clinicians to review cultural differences, resource limitations, and training expectations may improve the experience for visitors and hosts alike. <b>Disclosure:</b> Dr. Salasky has nothing to disclose. Dr. DiBiase has nothing to disclose. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives.

The unmet neurosurgical need has remained patent in developing countries, including Peru. However, continuous efforts to overcome the lack of affordable care have been achieved, being neurosurgical missions one of the main strategies. We chronicle the humanitarian labor of organizations from high-income countries during their visit to Peru, the contributions to local trainees' education, and the treatment of underserved patients. Furthermore, we discuss the embedded challenges from these missions and the future perspective on long-term partnerships and sustainability. This is a narrative review. We searched the literature in PubMed and Google Scholar about neurosurgical missions conducted in Peru. Since 1962, twelve organizations from high-income countries have delivered humanitarian help in Peru by training local neurosurgeons, treating low-income patients, and providing surgical instrumentation. Out of the three main regions of Peru, cities on the coast and highlands have hosted most of these missions, with no reported outreach in the amazon area. About 75% of the organizations are headquartered in the United States, followed by Canada, Luxembourg, and Spain. In addition, 50% of the organizations have an active partnership. The predominant focus of these missions has been pediatrics, neuro-oncology, and spine surgery. Neurosurgical missions have represented a strategy to close the disparity in education and treatment in Peru. However, additional efforts must be conducted to improve long-term partnership and sustainability, such as adopting standardized indicators for progress tracking, incorporating remote technologies for continuous training and communication, and expanding partnerships in less attended areas.

Telementoring for endoscopic submucosal dissection invivo training.

The provision of endoscopic training was significantly disrupted during the coronavirus disease (COVID-19) pandemic. It is difficult to provide training on endoscopic submucosal dissection (ESD) due to the complexity of the procedure and the shortage of local trainers. We have designed and conducted a simulation training course with telementoring, incorporating the concept of rapid cycle deliberate practice (RCDP). After a short tutorial on basic setup and maneuvering, the participants undergo 2 h of training on a live anesthetized pig to acquire the necessary skills for ESD. Two overseas experts were involved virtually in real time as telementors. A video camera was set up at each station, and both external and endoscopic views were transmitted live between the animal laboratory and telementors via the Zoom application. The overseas experts actively engaged in the simulation by giving live feedback and instructions to participants using visual aids supported by the meeting application. The training model utilized the concept of RCDP, where repeated immediate feedback and discussion would be carried out to enhance the efficiency of learning. Eighteen trainees were invited to participate in the course, six of them instructed by overseas telementors. Four ESD procedures were performed by participants under telementoring and achieved 100% en bloc resection without perforation. The times required for each ESD were similar with telementoring than that of on-site mentors. The establishment of telementoring has enabled knowledge and skill transfer of complex endoscopic procedures of ESD. With the limitations of international travel, this could be an alternative model allowing remote training, particularly when local experts are not readily available.

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study.

Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies. Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results. A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training. This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America

ABSTRACT Background Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. Objective To describe the process of development and cultural adaptation of the clinical intervention and training package. Methods We drew on Barrero and Castro’s four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement’s Going to Scale Framework. Results In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. Conclusion Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.

O018 A virtual reality training platform for surgeons, anaesthetists, and obstetricians in low and middle-income countries

Abstract Introduction Many surgeons, anaesthetists, and obstetricians in low and middle-income countries (LMICs) lack access to training opportunities. The purpose of this study was to evaluate the feasibility of VR procedural training at scale for these specialties. Methods An online, free to participant, single-day event programme was designed to cover operative anatomy and procedural steps for Bellwether procedures including Laparotomy and Caesarean section, use of a novel gasless laparoscopic surgery device, administration of spinal anaesthetic and basic trauma principles. Demonstration was performed using fresh frozen cadavers and virtual presentations. Faculty comprised of an equal split between UK and LMIC surgeons from a range of countries virtually connected. The 4K live 360°VR broadcast was achieved via vMix virtual video switcher. vMix Call remote broadcast contributor links and additional angles via NDI IP system. Results A total of 236 unique live views were generated. Participants were from 43 countries (n=17 high income countries: n=26 LMICs). In addition, fifty cardboard headsets were transported to two sites for dissemination to local trainees and students: Nairobi, Kenya, and Delhi, India. The mean per-user engagement time for the group was 132 minutes. Nine LMICs had an average per country user engagement of &amp;gt;140 minutes. Conclusion It is feasible to live stream surgical training videos in VR and achieve significant user engagement for participants from LMICs. This technology allowed resources and faculty in a HIC setting to collaborate in real-time with faculty input from LMIC via virtual reality, facilitating multi-directional learning. Take-home message Live virtual reality surgical training courses are feasible and can provide scalable learning environments, achieving significant engagement from surgeons, obstetricians and anaesthetists across the world, including several low and middle-income countries.