“This course will help me to give good quality care to my patients,” said nurse Ramatu, after participating in a simulation-based training course facilitated by King’s Sierra Leone Partnership (KSLP). The course uses scenarios to help teach the real-life skills required to manage the acutely unwell patients who routinely attend Connaught Hospital in Freetown.
Simulation for real-life scenarios
As the main medical, surgical and referral centre in Sierra Leone many of the newly trained nurses and doctors begin their working careers at Connaught Hospital. As students, most nurses and doctors gain a sound theoretical knowledge of healthcare but have very little practical skills training, so they lack the vital skills required to work effectively within the hospital environment. Part of our mission at KSLP is to work in partnership with teams at Connaught Hospital to ensure staff can apply theoretical knowledge towards safe, effective patient care. Simulation-based training is a proven way to do this, which is increasingly being used in such settings.
Simulation training uses artificial aides to replicate real-life scenarios, creating a learning environment in which patient care is not compromised. Using patient models, spare equipment and tools for patient observations, simulations allow students to experience clinical situations, developing the knowledge and skills required to manage them. It can be particularly useful in developing the ‘non-technical skills’ – including communication, team working, leadership and task coordination – which are essential for improving patient care and preventing errors. Research shows that up to 80 per cent of anaesthetic incidents occur because of failure of non-technical skills.
Assistance from the Royal College of Anaesthetists (RCOA)
Simulation is a valuable tool in medical education, but it is less commonly used in low-resource settings. High costs coupled with significant human and logistical barriers contribute to this. Since 2018, the UK Royal College of Anaesthetists (RCOA) has supported simulation as an educational tool at Connaught Hospital. By funding volunteers to be placed here we have been able to establish regular simulation training through specially designed and tailored educational courses. Connaught Hospital has also benefitted from the donation of a high-fidelity simulation manikin and equipment by the RCOA. With real-time speech, breath sounds and respiratory effort, the manikin provides an immersive experience for trainees and facilitates learning by creating more realistic clinical scenarios.
Simulation as an essential part of staff training
KSLP has helped to ensure that simulation forms an increasing part of training at Connaught Hospital, and complements other education delivered in the form of lectures, practical sessions and clinical mentorship. Courses have been developed and delivered by subsequent volunteers, ensuring continuity and an ongoing educational presence within Connaught.
One of the most established training courses, the RATES Course (Recognition and Treatment of Emergencies in Sierra Leone) uses simulation to underpin many of the key teaching points. Through five scenarios, junior doctors lead and manage simulated medical emergencies in a safe environment, developing leadership and task prioritisation skills. They also learn to manage specific emergency medical conditions which they may not yet have encountered or had to treat independently in clinical practice.
One scenario focuses on the management of the seizing patient, a situation doctors often report feeling unsure of how to handle. These sessions provide a chance for them to practice administering basic management in a safe environment, with feedback provided on areas they might improve on. It allows discussion as a group of any areas they may be unsure and a chance to discuss any particular local issues or preconceptions that may hamper treatment.
Another of our scenarios focuses on sepsis, which remains a global killer and is a common reason for admission. Through the use of simulation, we are able to reinforce the key management goal and the time critical nature of treatment for sepsis if good outcomes are to be achieved. It also allows us to provide additional education through discussion such as linking into the antibiotic guidelines that KSLP has helped develop within the hospital, and the importance of prompt clear referral for senior or intensive care support.
Nurses are also benefiting from simulation training at Connaught. The ‘mini-RATES for nurses’ course has been designed to help nurses build confidence in assessing the unwell patient and develop the skills required to help manage critically unwell patients. Other courses are multi-disciplinary, with doctors and nurses training together. The Primary Trauma Care (PTC) course and a newly implemented Resuscitation Course teach basic life support skills. Both courses have core simulation elements, where doctors and nurses of all specialties train in tandem, promoting teamworking and interpersonal communication.
At KSLP we aim to work in partnership with local staff at Connaught Hospital. Several staff have now been trained to help conduct simulated scenarios for the RATES, mini-RATES and PTC courses. These facilitators are now being integrated into the training courses, receiving further mentorship during each session.
Feedback from participants on courses has been very positive, reinforcing the importance of using simulation alongside traditional techniques. Participants find it a useful tool for the hospital setting, helping to build confidence and teamworking.
Building my skills as a volunteer
As a KSLP volunteer, undertaking simulation training has been a fantastic way to engage with the staff at Connaught Hospital. Working with so many different staff at different stages of their training with different levels of experience has helped me to develop my teaching skills, becoming adaptable to the trainees present and sensitive to the specific needs of the group. It has also been a great way of understanding many of the issues that are faced by staff within the hospital and allowed us to engage in discussion after the simulation scenarios on ways these could be overcome.
As an emerging learning technique, simulation has been embraced by medical professionals at Connaught Hospital. Looking to the future we hope it will play a continued and important role in improving the safety of patient care within the hospital. In addition to regular courses to facilitate quality care of the medical and trauma patient, we aim to offer regular simulation training courses in surgery and critical care and anaesthesia, building on a recently delivered Safer Anaesthesia from Education (SAFE) course. We aim to develop a formalised training and mentorship scheme to train simulation facilitators from the hospital. Most of all, we hope that the use of simulation will continue to be embraced at Connaught Hospital and across Sierra Leone.