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.

Life in Freetown

 by Linda Jenkins, KSLP Nurse Educator

 

 

I came to Freetown in August 2016 hoping to use my training skills and nursing/midwifery knowledge to work with partners at the faculty of nursing but wasn’t at all sure what the role entailed as I was this was the first KSLP volunteer post in nurse education. Joining a team of skilled medical volunteers seemed daunting at first, but the sense of camaraderie and fun was good as we adjusted to conditions and challenges but also enjoyed the benefits of Salone life (beaches, bars and fresh fish & seafood). I found common ground with some of the nurses who had worked through the Ebola epidemic which helped us create a voice for nursing amongst the medics and researchers!

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It is strange for me to feel that though it’s been many years since I worked in West Africa (I spent three years in a village in Burkina and two in The Gambia) some things are still the same – the heat; the noise; the colours; the music; the pace of life. The welcome for us all is big here although the country has suffered a great deal. Before I arrived, I had some insights through listening to my partner who has spent many years working with Sierra Leone Red Cross and from my daughter who spent time here too. My colleagues at the faculty of nursing are inventive when dealing with the challenges that face them – poor conditions in offices and classrooms; no electricity or water and plenty of students. They accepted me as a partner and I enjoyed getting to know them as friends too. I feel having experience of living in Africa helped me and them to communicate and build relationships, which is the core to partnership working. There are naturally challenges for me and for them. For me it’s taking time to understand and see how things work. It’s never time wasted. For them it’s understanding that Kings doesn’t always bring money but offers skills and connections.

There is no doubt the role that Kings played during Ebola created a positive attitude towards Kings volunteers and this helps forge relationships. I’ve both enjoyed and been frustrated when working here but possibly no more than in my previous NHS role! The work on the curriculum development, sharing the frustrations of the nursing lecturers, meeting the students and invigilating at exams are all highlights of my working time here. The beaches, developing a suntan and being able to work near my partner were highlights of my home life here. There are plenty of outlets for activities outside work like beach walks, (watching) running, swimming, bars and a large international church group to be involved with. As anywhere in low resource countries, it’s getting your head around the obvious contrasts in contexts of poverty and the rural/urban split that is hard. Despite this, the experience is huge and rewarding.

We are currently looking for a new Nurse Educator to replace Linda as she moves onto pastures new – please check our Volunteer page for more details. To apply, please submit a covering letter (maximum 2 pages) and CV (maximum 4 pages) to volunteer@kslp.org.uk before midnight on Sunday 24th September.

Designing a Development Programme for the Faculty of Nursing Lecturers

The King’s Sierra Leone Partnership is moving into an exciting phase with our partners at the Faculty of Nursing at the College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone.

On 3rd November 2016, Sister Alicia Wilson-Taylor, Senior Nurse Lecturer at COMAHS, and Dr Matthew Vandy, Dean of the Faculty, co-led an interactive workshop with the support of Linda Jenkins, KSLP’s Nurse Educator. The workshop built on teaching sessions started with COMAHS in 2013/14, before the Ebola outbreak halted this work, and outlined current plans to design a development programme for the faculty of nursing lecturers.

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Topics of discussion included developing skills in carrying out teaching observations, peer evaluation of teaching, student assessment, ward teaching, research, and the use of IT. The session was attended by 8 of the faculty lecturers.

Sister Wilson-Taylor shared with the group an inspiring example of using interactive learning in a teaching session the previous day where students had been asked to work in pairs to define the characteristics of a nurse and feedback to the group. Sister Wilson-Taylor said the session had been very successful and that the students came up with great ideas and the team is looking forward to future sessions.

kslp-and-faculty-of-nursing-at-comahs-photo-1 Dr Vandy, Sister Wilson-Taylor, and colleagues will be working over the next 10 months, supported by Linda, to develop the nursing curriculum, teaching, and assessment methods and use the learning from similar work that has already taken place in the Faculty of Medicine, also supported by KSLP’s Education Manager Suzanne Thomas.

IPC Campaign Week

As part of our ongoing work with the Infection Prevention & Control (IPC) Programme, KSLP IPC nurse mentors have been supporting partners at Connaught, Lumley and King Harman Road Hospitals to implement regular IPC campaign weeks. These weeks have proven effective in building and maintaining enthusiasm among hospital staff about the importance of following IPC protocols.

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Hand washing during one of Connaught’s IPC weeks in May

Each IPC week is different, but typically each day of the week has a particular theme for which the IPC Focal Person collaborates with the link nurses to focus the day’s training and monitoring on one particular component of IPC.

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Bobson Fofanah explaining the correct disposal of sharps

For instance, this September featured Sharps Safety Day at King Harman Road Hospital. Assistant IPC Focal Person Bobson Fofanah visited each ward to ensure that sharps bins were assembled correctly and located in safe places in each ward. He also checked to see if there are instructional posters in place and to make sure every staff member is aware of the importance of proper sharps disposal.

IPC campaign weeks build a strong sense of teamwork and enthusiasm about IPC across the hospitals. The week ends with a celebration, with awards given to the wards showing improvement in IPC practices.

IPC weeks also give the team opportunities to show off their creativity!

King Harman Road Nurses sing the IPC Song from King’s Sierra Leone Partnership on Vimeo.