Understanding the barriers and enablers for postgraduate medical trainees becoming simulation educators: a qualitative study.

INTRODUCTION : There is increasing evidence that Simulation-based learning (SBL) is an effective teaching method for healthcare professionals. However, SBL requires a large number of faculty to facilitate small group sessions. Like many other African contexts, Mbarara University of Science and Technology (MUST) in Uganda has large numbers of medical students, but limited resources, including limited simulation trained teaching faculty. Postgraduate medical trainees (PGs) are often involved in clinical teaching of undergraduates. To establish sustainable SBL in undergraduate medical education (UME), the support of PGs is crucial, making it critical to understand the enablers and barriers of PGs to become simulation educators. METHODS: We used purposive sampling and conducted in-depth interviews (IDIs) with the PGs, key informant interviews (KIIs) with university staff, and focus group discussions (FGDs) with the PGs in groups of 5-10 participants. Data collection tools were developed using the Consolidated framework for implementation research (CFIR) tool. Data were analyzed using the rigorous and accelerated data reduction (RADaR) technique. RESULTS: We conducted seven IDIs, seven KIIs and four focus group discussions. The barriers identified included: competing time demands, negative attitude towards transferability of simulation learning, inadequacy of medical simulation equipment, and that medical simulation facilitation is not integrated in the PGs curriculum. The enablers included: perceived benefits of medical simulation to medical students plus PGs and in-practice health personnel, favorable departmental attitude, enthusiasm of PGs to be simulation educators, and improved awareness of the duties of a simulation educator. Participants recommended sensitization of key stakeholders to simulation, training and motivation of PG educators, and evaluation of the impact of a medical simulation program that involves PGs as educators. CONCLUSION: In the context of a low resource setting with large undergraduate classes and limited faculty members, SBL can assist in clinical skill acquisition. Training of PGs as simulation educators should address perceived barriers and integration of SBL into UME. Involvement of departmental leadership and obtaining their approval is critical in the involvement of PGs as simulation educators.

Global health electives: Ethical engagement in building global health capacity.

Purpose: Little is known about the impact medical trainees undertaking global health electives (GHEs) have on host institutions and their communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with GHEs as perceived by host stakeholders at three sites in sub-Saharan Africa.Method: This case-based interpretive phenomenological study examined stakeholder perspectives in Mwanza, Tanzania, and Mbarara and Rugazi, Uganda, where the University of Calgary, Alberta, Canada has long-standing institutional collaborations. Between September and November 2017, 33 host stakeholders participated in semi-structured interviews and 28 host stakeholders participated in focus group discussions. Participant experiences were analyzed using interpretive phenomenological techniques.Results: The findings revealed that, although GHEs are well-established and a common experience for host stakeholders, their perceptions about who visiting medical trainees (VMTs) are remains indistinct. Participants acknowledged that there are a variety of benefits to GHEs, but overall VMTs appear to benefit the most from this unique learning opportunity. Host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved.Conclusions: GHEs need to be designed to better embrace ethical engagement and reciprocity with host stakeholders to ensure equity in benefits and responsibilities.

Developing consensus for postgraduate global health electives: definitions, pre-departure training and post-return debriefing.

BACKGROUND: Global health (GH) electives are on the rise, but with little consensus on the need or content of pre-departure training (PDT) or post-return debriefing (PRD) for electives in postgraduate medical education. METHODS: Using a 2-iteration Delphi process to encourage discussion and consensus, participants from 14 medical schools across Canada provided input to promote more uniform policy towards defining GH electives, when PDT and PRD should be mandatory and what curriculum should be included. RESULTS: There is consensus that PDT and PRD should be mandatory for international electives. Respondents felt that PDT should include a broad range of topics including objectives, travel safety, personal health, logistics, ethics of GH, scope of practice/supervision, and cultural awareness. PRD should include elective evaluation, lessons learned, knowledge translation, review of health and safety, and issues of reintegration. The format of PDT and PRD needs to be individualized to each institution to fit within the limitations of faculty who can serve as facilitators. Global health educators agreed on the importance of mandatory PDT and PRD for remote Canadian aboriginal electives, but did not feel that they could make recommendations without additional input of aboriginal scholars. CONCLUSIONS: All residency programs that send residents on international electives should work towards instituting quality, mandatory PDT and PRD. PDT and PRD should be recognized by universities as having academic merit and by program directors as core resident learning activities. Curriculum and objectives could be arranged around CanMEDS competencies, a physician competency framework that emphasizes qualities beyond medical expert such as professionalism, health advocate, and collaborator.

Assessing personal contributions in global surgery: By whose yardstick?

Over the past 2 decades, interest and involvement in global surgery as an evolving discipline have increased among practitioners and trainees. A demand for formal evaluation of global surgery projects has also increased with demands for outcomes and impact. However, there has been little or no encouragement or requirement for participants to formally assess their personal contribution either to a project or to the discipline itself owing to the volunteer-based nature of those involved. Though participant contribution cannot be easily measured, the experience can be used to foster professional development. We propose that this neglected opportunity be addressed and suggest a framework of intentional reflection and mentorship that can be applied as an integral part of the global surgery experience, from participants election through debriefing after the experience.

Using CanMEDS to guide international health electives: an enriching experience in Uganda defined for a Canadian surgery resident.

BACKGROUND: Surgery residents who wish to travel during their residency will often seek an elective experience in a low-or middle-income country. Objectives for international health electives (IHEs) are often vague and poorly defined. Further, feedback to, and evaluation of, the resident after the IHE are often not specific because international preceptors are not familiar with the desired educational outcomes of Canadian residency programs. Residents who choose an elective in a low-income country usually anticipate that they will contribute some medical service to an existing impoverished health care system, and in this setting, they hope to gain exposure to a high operative volume with potentially fewer institutional and administrative obstacles. METHODS: In this paper, we describe one resident's elective experience in Mbarara, Uganda. In addition to her clinical experience, the resident performed a retrospective audit of surgical admissions. After her elective, we asked the resident to reflect on her experience and to use the Canadian Medical Education Directives for Specialists (CanMEDS) framework to describe the challenges she encountered and to define the learning outcomes gained with respect to each CanMEDS role. RESULTS: We discovered that the resident had a rich and insightful educational experience when discussed in this context. As a result, we have created a guide for structuring postgraduate IHEs around the CanMEDS roles, using them to ask pre-and postelective questions to develop relevant and practical IHE objectives. CONCLUSION: We propose that this guide has the potential to improve both resident preparation before international experience and also subsequent evaluation of resident performance in this ill-defined area. More important, we found that IHEs are a useful vehicle to evaluate resident achievement of the CanMEDS competencies in a way that is reflective, realistic and representative of the multiple challenges involved when working in international health.