Straube Steven, Chang-Bullick Julia, Nicholaus Paulina, Mfinanga Juma, Rose Christian, Nichols Taylor, Hackner Daniel, Murphy Shelby, Sawe Hendry, Tenner Andrea
Department of Emergency Medicine, 533, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA, USA.
Department of Emergency Medicine, Muhimbili National Hospital, Malik Road, Dar es Salaam, Tanzania.
Afr J Emerg Med. 2020 Mar;10(1):30-34. doi: 10.1016/j.afjem.2019.11.003. Epub 2020 Jan 23.
The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, in-person course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BEC-App) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting.
We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts.
A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%.
Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate.
世界卫生组织（WHO）的基础急救课程（BEC）是一门为期五天的面授课程，涵盖基本评估和救生干预措施。我们为WHO的BEC开发了两种新颖的辅助工具：一套用于模拟患者护理的临床病例（BEC-病例）和一个供参考的手机应用程序（BEC-应用）。目的是确定在资源匮乏地区，以翻转课堂的方式使用这些教育辅助工具是否能提高医护人员的知识获取和保留能力。
我们于2017年10月至2018年2月在坦桑尼亚滨海地区的两家区级医院进行了一项前瞻性队列研究。使用描述性统计、Fisher精确t检验和Wilcoxon秩和检验来检查使用这些辅助工具是否能提高学习者的知识水平。参与者根据地点分为两组；第1组接受BEC课程，第2组除了接受BEC课程外，还接受BEC-病例和BEC-应用。两组在BEC课程前后以及7个月的随访考试中都进行了测试。所有参与者都被邀请参加关于课程和辅助工具的焦点小组讨论。
总共纳入了24名参与者，其中12名（50%）完成了随访。第1组的平均预测试分数（50%）与第2组（53%）相似（p = 0.52）。BEC课程后，两组的测试分数都有所提高，第1组（74%）和第2组（87%），（p = 0.03）。在7个月的随访中，尽管有大量参与者失访，但第1组的平均随访考试分数为66%，第2组为74%。
为WHO的BEC课程实施翻转课堂教育辅助工具是可行的，并且可能会提高资源匮乏地区医护人员的学习效果。我们的焦点小组反馈表明，该课程和辅助工具用户友好且符合文化背景。
