Stanley Lilian, Min Thaw Htwe, Than Hla Hla, Stolbrink Marie, McGregor Kathryn, Chu Cindy, Nosten François H, McGready Rose
Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110 Bangkok, Thailand.
Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110 Bangkok, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand ; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.
Confl Health. 2015 Apr 13;9:11. doi: 10.1186/s13031-015-0041-x. eCollection 2015.
Shoklo Malaria Research Unit has been providing health care in remote clinics on the Thai-Myanmar border to refugee and migrant populations since 1986 and 1995, respectively. Clinics are staffed by local health workers with a variety of training and experience. The need for a tool to improve the competence of local health workers in basic emergency assessment and management was recognised by medical faculty after observing the case mix seen at the clinic and reviewing the teaching programme that had been delivered in the past year (Jan-13 to March-14).
To pilot the development and evaluation of a simple teaching tool to improve competence in the assessment and management of acutely unwell patients by local health workers that can be delivered onsite with minimal resources.
A structured approach to common emergencies presenting to rural clinics and utilizing equipment available in the clinics was developed. A prospective repeated-measures observed structured clinical examination (OSCE) assessment design was used to score participants in their competence to assess and manage a scenario based 'emergency patient' at baseline, immediately post-course, and 8 weeks after the delivery of the teaching course. The assessment was conducted at 3 clinic sites and staff participation was voluntary. Participants filled out questionnaires on their confidence with different scenario based emergency patients.
All staff who underwent the baseline assessment failed to carry out the essential steps in initial emergency assessment and management of an unconscious patient scenario. Following delivery of the teaching session, all groups showed improved competence in both objective assessment and subjective confidence levels.
Structured and practical teaching and learning with minimal theory in this resource limited setting had a positive short-term effect on the competence of individual staff to carry out an initial assessment and manage an acutely unwell patient. Health-worker confidence likewise improved. Workplace assessments are needed to determine if this type of skills training impacts upon mortality or near miss mortality patients at the clinic.
自1986年和1995年起，洛克洛疟疾研究单位分别开始在泰缅边境的偏远诊所为难民和移民群体提供医疗服务。诊所的工作人员是接受过各种培训且经验各异的当地卫生工作者。医学院在观察了诊所的病例组合并回顾了过去一年（2013年1月至2014年3月）所开展的教学项目后，认识到需要一种工具来提高当地卫生工作者在基本急救评估和管理方面的能力。
试行开发和评估一种简单的教学工具，以提高当地卫生工作者对急性病患者进行评估和管理的能力，该工具可在资源最少的现场进行传授。
针对农村诊所常见的紧急情况制定了一种结构化方法，并利用诊所现有的设备。采用前瞻性重复测量观察性结构化临床考试（OSCE）评估设计，对参与者在基线、课程结束后即刻以及教学课程结束8周时评估和管理基于模拟场景的“急诊患者”的能力进行评分。评估在3个诊所地点进行，工作人员自愿参与。参与者填写了关于他们对不同模拟场景急诊患者的信心的问卷。
所有接受基线评估的工作人员在对昏迷患者场景进行初始急救评估和管理时均未能执行基本步骤。在进行教学课程后，所有组在客观评估和主观信心水平方面的能力均有所提高。
在这种资源有限的环境中，进行结构化且注重实践、理论最少的教学与学习，对个体工作人员进行初始评估和管理急性病患者的能力产生了积极的短期影响。卫生工作者的信心也得到了提高。需要进行工作场所评估，以确定这种技能培训是否会对诊所的死亡率或接近死亡的患者产生影响。
