Simulation training in low-resource countries
This project is a 2020 recipient of grant funding from the Royal College’s new International Development, Aid and Collaboration (IDAC) program. This grant supports projects that improve health profession education and local capacity in low- and middle-income countries.
Roughly five billion of the world’s seven billion people lack access to safe anesthesia and surgical care, in part because of global shortages of trained perioperative health care providers.
Dalhousie University’s Patricia Livingston, MD, FRCPC, is leading a team — along with Australian colleague Adam Mossenson, MD, and Rwandan colleague Christian Mukwesi, MD — to make simulation training for perioperative skills widely available in low-resource settings.
Vital Anaesthesia Simulation Training (VAST) is a three-day simulation program where participants manage clinical scenarios involving trauma, pediatrics, obstetrics and intra-operative emergencies. The course arose from a longstanding collaboration for anesthesia education between Dalhousie University and the University of Rwanda.
“VAST focuses on systematic practice and non-technical skills, such as team communication, decision-making, situational awareness and task management,” said Dr. Livingston. “Health care teams need these skills to function effectively in delivering anesthesia and surgical care.”
A simple, low-cost solution
Simulation is a powerful teaching method for medical education; however, it is difficult to deliver in low-resource settings where simulation materials are often absent and qualified educators are in short supply. VAST addresses these barriers through a simple, low-cost program that is transportable and widely deliverable. The VAST course provides all the materials a health care team needs to conduct its own simulation activities.
“VAST doesn’t rely on expensive mannequins,” said Dr. Livingston. “Instead, the participants use role-play, briefing cards and scripts for most scenarios. Realistic patient monitoring is created using two paired iPads and the SimMon app.”
Improving facilitator training
An evaluation of VAST, published in the British Journal of Anaesthesia, demonstrates that non-technical skills were significantly improved by the course and these improvements were maintained four months after the simulation training. VAST is endorsed by the World Federation of Societies of Anaesthesiologists.
The next step is to improve methods for facilitator training. Dr. Livingston’s team will use Royal College IDAC funding to develop and test a competency matrix for VAST facilitators and to strengthen training experiences required to achieve excellence at VAST facilitation. This will build capacity for simulation-based medical education in low-resource settings.
“We will know we have succeeded when VAST courses can be delivered worldwide by local health care providers without the need for external support,” said Dr. Livingston.
 Mossenson A, Tuyishime E et al. Promoting anesthesia providers’ non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting. British journal of anaesthesia. 2020; 124 (2): 206-213.
Due to COVID-19 and travel restrictions, a number of project activities originally planned for earlier this year have been delayed. Some activities have since restarted, while others are waiting for an appropriate and safe time to resume.