Simulation Training as a Learning Tool at Connaught Hospital

Alistair Cranfield, Anaesthetist and KSLP volunteer writes about the simulation training courses he delivered to healthcare workers at Connaught Hospital in Freetown. Using artificial aids to replicate real-life scenarios, health workers gain practical skills to ensure safe and effective patient care.

“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.

Healthcare workers take part in a training with a high-fidelity simulation manikin

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.

Volunteer, Chris Curry delivers simulation training to staff at Connaught Hospital

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.

World Malaria Day at Connaught

25th April is World Malaria Day. In this blog, Rosie (Labs Volunteer) and Lisa (Implementation Coordinator) provide insight into why continued work on malaria is so important, and how KSLP (supported by Comic Relief) are contributing to the fight against this disease.

 

Malaria claims the life of at least 1 child every 2 minutes globally, and despite extensive international efforts it remains a major cause of mortality, with approximately 90% of malaria-related deaths occurring in children under 5 years old. Other at-risk groups include pregnant women and immunocompromised persons.

You have probably heard of it, but what exactly is malaria?

Malaria is a life-threatening disease caused by parasites that are transmitted person to person through the bites of infected mosquitos. The infected Anopheles mosquitoes typically bite at night and breed in shallow puddles of water.

What are the symptoms?

Symptoms can be very non-specific but can include fevers, shaking chills, headaches, muscle aches, nausea, vomiting and diarrhoea. Left untreated it may cause kidney failure, seizures, mental confusion, comas and death.

How does malaria affect Sierra Leone?

In Sierra Leone, the WHO estimated there were around ~2,000,000 malaria cases and ~7,000 deaths in 2016.

Evidence has shown malaria can slow economic growth by ~1% annually. Education is also hit, with approximately 60% of school age children impaired by absenteeism due to malaria in endemic areas.

But wait, there is some good news!

In 2015, all countries in the WHO European Region reported, for the first time, reported zero indigenous cases of malaria (down from 90,000 cases in 1995). From 2007-2015, Armenia, Maldives, Morocco, Turkmenistan and United Arab Emirates also all became certified malaria-free by WHO.

Future WHO malaria elimination targets aim to add at least 10 countries to this malaria-free list by 2020, at least 20 by 2025 & at least 35 by 2030.  This gives us the evidence and hope that it is possible to beat malaria, not just in Sierra Leone, but globally!

What is being done by KSLP to reduce the burden of malaria in Sierra Leone?

In September 2017, a project began between King’s Sierra Leone Partnership, University of Sierra Leone Teaching Hospitals Complex-Connaught and the Ministry of Health’s National Malaria Programme, to improve malaria management at the hospital level called: ‘Strengthening Health systems to Improve Fever management (SHIFT)’.

The project began with a 6-month baseline assessment that used a combination of quantitative (clinical audit and healthcare worker surveys) and qualitative (process mapping, focus groups, key informant interviews, and patient observations) methods to comprehensively understand the barriers to providing high quality malaria care in hospital. The baseline findings are now being used to inform and design project interventions, aimed at improving hospital service provision, staff knowledge, and data management with regards to malaria management.

A rapid diagnostic test (RDT) in action

KSLP, Connaught and the NMCP have collaborated to integrate malaria rapid diagnostic tests (RDT) into the hospital as a standard service since March 2018. These free tests provide patients with a quick malaria result (within 20 minutes) and if positive, the patient can obtain a prescription for free malaria treatment. We hope the introduction of RDTs (as well as new automatic haematology and biochemistry analysers!), will help lighten the manual workload for laboratory staff, providing more opportunity for on the job learning, and blood film preparation, staining and examination under the microscope.

RDTs are undoubtedly a great resource, however microscopic diagnosis is the global gold standard. It enables both quantification of parasites in the blood, as well as, species differentiation therefore providing essential epidemiological data. Going forward the project will continue to build capacity within the laboratory, focusing on the quality and turn-around-time for all malaria diagnostics.

Additional current project efforts include developing standard operating procedures and diagnostic and management protocols (including job aids) to align care with NMCP guidelines and strengthening the malaria data management in the Accident and Emergency (A&E), Laboratory, Pharmacy, Surveillance, and Monitoring and Evaluation departments. Each of the project elements link with the hospital’s quality improvement committee to coordinate multidisciplinary learning and service evaluation review.

In subsequent months the project aims to further harmonize the hospital data continuity through the integration of a simple electronic data collection and information system.  The interventions also include a training and mentorship programme for healthcare workers on malaria diagnosis and management.

How will this project help others in Sierra Leone outside of Connaught?

At the project’s conclusion, baseline assessment and implementation toolkits will be developed to support the replication of the project’s successes. Ministry of Health officials will then support the dissemination of these toolkits to other national hospitals!