Sanseau Elizabeth, Thomas Anita, Jacob-Files Elizabeth, Calhoun Asela, Romero Susan, Kant Shruti
General Pediatrics: Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
Pediatrics, Seattle Children's Hospital, Seattle, USA.
Cureus. 2020 May 26;12(5):e8288. doi: 10.7759/cureus.8288.
Introduction Simulation-based continuing education (SBCE) is a widely used tool to improve healthcare workforce performance. Healthcare providers working in geographically remote and resource-limited settings face many challenges, including the development and application of SBCE. Here, we describe the development, trial, and evaluation of an SBCE curriculum in an Alaska Native healthcare system with the aim to understand SBCE feasibility and specific limitations. Methods The perceived feasibility and efficacy of incorporating a low-fidelity medical simulation curriculum into this Native Alaskan healthcare system was evaluated by analyzing semi-structured interviews, focus groups, and surveys over a 15-month period (August 2018 - October 2019). Subjects were identified via both convenience and purposive sampling. Included were 40 healthcare workers who participated in the simulation curriculum, three local educators who were trained in and subsequently facilitated simulations, and seven institutional leaders identified as "key informants." Data included surveys with the Likert scale and dichotomous positive or negative data, as well as a thematic analysis of the qualitative portion of participant survey responses, focus group interviews of educators, and semi-structured interviews of key informants. Based on these data, feasibility was assessed in four domains: acceptability, demand, practicality, and implementation. Results Stakeholders and participants had positive buy-in for SBCE, recognizing the potential to improve provider confidence, standardize medical care, and improve teamwork and communication, all factors identified to optimize patient safety. The strengths listed support feasibility in terms of acceptability and demand. A number of challenges in the realms of practicality and implementation were identified, including institutional buy-in, need for a program champion in a setting of staff high turnover, and practicalities of scheduling and accessing participants working in one system across a vast and remote geographic region. Participants perceived the simulations to be effective and feasible. Conclusion While simulation participants valued an SBCE program, institutional leaders and educators identified veritable obstacles to the practical implementation of a structured program. Given the inherent challenges of this setting, a traditional simulation curriculum is unlikely to be fully feasibly integrated. However, due to the overall demand and social acceptability expressed by the participants, innovative ways to deliver simulation should be developed, trialed, and evaluated in the future.
基于模拟的继续教育（SBCE）是一种广泛应用于提升医疗保健人员工作绩效的工具。在地理位置偏远且资源有限环境中工作的医疗服务提供者面临诸多挑战，包括SBCE的开发与应用。在此，我们描述了阿拉斯加原住民医疗系统中SBCE课程的开发、试验与评估，旨在了解SBCE的可行性及特定局限性。
通过在15个月期间（2018年8月至2019年10月）分析半结构化访谈、焦点小组讨论和调查，评估将低保真度医学模拟课程纳入阿拉斯加原住民医疗系统的可行性和有效性。通过便利抽样和目的抽样确定研究对象。纳入了40名参与模拟课程的医护人员、3名接受过模拟培训并随后协助进行模拟的当地教育工作者以及7名被确定为“关键信息提供者”的机构领导者。数据包括李克特量表调查以及二分法的正面或负面数据，以及对参与者调查回复的定性部分、教育工作者焦点小组访谈和关键信息提供者半结构化访谈的主题分析。基于这些数据，在四个领域评估可行性：可接受性、需求、实用性和实施。
利益相关者和参与者对SBCE持积极支持态度，认识到其在提高提供者信心、规范医疗护理以及改善团队合作与沟通方面的潜力，所有这些因素均被视为优化患者安全的关键。所列出的优势在可接受性和需求方面支持了可行性。在实用性和实施领域确定了一些挑战，包括机构支持、在员工高流动率环境中需要项目倡导者，以及在广阔偏远地理区域内安排和接触在一个系统中工作的参与者的实际问题。参与者认为模拟是有效且可行的。
虽然模拟参与者重视SBCE项目，但机构领导者和教育工作者指出了结构化项目实际实施中的切实障碍。鉴于此环境的固有挑战，传统模拟课程不太可能完全可行地整合。然而，由于参与者表达的总体需求和社会可接受性，未来应开发、试验和评估创新的模拟交付方式。
