Abstract
Health-care providers in rural and remote areas do not have the same access to training as those in urban areas. This poses a serious challenge to equitable health-care delivery. This paper outlines the development and piloting of a mobile tele-simulation unit (MTU) prototype to address the challenges of training in rural and remote settings. The goal of the MTU is to increase opportunities for emergency health-care providers to access training remotely. Mobile tele-simulation is a novel approach to remote medical training with many potential benefits. However, one must take into consideration the effective development and implementation of such a unit. In this paper, we describe our multidisciplinary mixed-methods approach to develop and pilot the MTU using proven theoretical frameworks. We also discuss the developmental challenges, and findings on trainee satisfaction and learning outcomes. Initial results are promising and warrant a formal evaluation.
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Acknowledgments
This project has been supported by an Ignite RDC grant awarded by the Research and Development Corporation of Newfoundland and Labrador. Thanks to the following organizations at Memorial University of Newfoundland: the Tuckamore Simulation Research Collaborative (TSRC) for research support and advice, the Clinical Learning and Simulation Center (CLSC) for equipment and operational support, and MUN Med 3D for the provision of simulation models. Thank you to the following people for their assistance during this research project: Research Assistants Megan Pollard, Samantha Noseworthy and Sarah Boyd; Tate Skinner (technical support), Joanne Doyle (Emergency Medicine discipline secretary), and Memorial University’s Emergency Medicine Interest Group (EMIG).
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Appendices
Appendix A – Aim-FineTune-FollowThrough Approach
Sample of MCMD to identify the design factors to consider during prototype development of the MTU
Appendix B – Procedural Skills Questions
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1.
Name 3 indications for chest tube placement:
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2.
Name 2 contra-indications to chest tube placement:
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3.
Name 4 potential complications of chest tube placement:
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4.
Name 5 essential pieces of equipment for chest tube placement:
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5.
What is the typical location on the chest wall for placement of a chest tube?
Appendix C – Mean and Standard Deviation of MTU Characteristics
Characteristic | SessionA N = 35 | SessionB N = 6 | SessionC N = 6 (Remote) | SessionC N = 6 (Face-to-face) | Mann-Whitney U test Session C remote vs. Face-to-face |
|---|---|---|---|---|---|
Design features of MTU | |||||
Well organized | 4.00 (0.594) | 4.33 (0.516) | 4.33 (0.816) | 4.83 (0.408) | |
Good lighting/brightness | 3.94 (0.873) | 4.50 (0.548) | 4.50 (0.548) | 4.50 (0.548) | |
Low noise | 4.23 (0.646) | 2.67 (1.211) | 3.5 (1.378) | 4.67 (0.516) | |
Adequate space | 3.89 (0.867) | 4.33 (0.516) | 4.67 (0.516) | 4.67 (0.516) | |
Function of telecommunications | |||||
Camera setup/location | 4.17 (1.465) | 4.00 (1.095) | 4.17 (0.408) | N/A | |
Audio | 4.09 (0.853) | 2.83 (1.169) | 3.33 (0.816) | N/A | |
Satisfied with MTU | 3.90 (0.746) | 4.00 (0.632) | 4.50 (0.548) | 4.5 (0.837) | |
Recommend MTU | 4.09 (0.712) | 4.67 (0.516) | 4.50 (0.548) | 4.17 (1.169) | |
Design elements of the training session | |||||
Adapted from the NLN Simulation Design Scale (NLN 2005) | |||||
Objectives and information | |||||
There is enough information provided before the session to provide direction and encouragement. | 3.83 (1.169) | 3.67 (0.816) | 4.17 (1.329) | U = 70, z = 1.158, p = 0.310 | |
I clearly understood the purpose and objectives of the session. | 4.17 (0.408) | 4.33 (0.516) | 4.50 (0.837) | U = 59, z = 0.371, p = 0.770 | |
The session provided enough information in a clear matter for me to problem-solve the situation. | 3.83 (0.983) | 3.67 (0.816) | 4.17 (0.408) | U = 65.5, z = 1.01, p = 0.454 | |
I learn from the comments made by the teacher before, during, or after the simulation. | 3.5 (1.049) | 4.17 (0.408) | 4.17 (0.753) | U = 66.5, z = 0.962, p = 0.415 | |
The cues are appropriate and geared to promote my understanding. | 3.67 (1.033) | 3.83 (0.408) | 4.5 (0.548) | U = 80.5, z = 2.142, p = 0.077 | |
Characteristic | SessionA N = 35 | SessionB N = 6 | SessionC N = 6 (Remote) | SessionC N = 6 (Face-to-face) | Mann-Whitney U test Session C remote vs. Face-to-face |
|---|---|---|---|---|---|
There is enough information provided to me during the session. | 3.67 (1.033) | 3.83 (0.408) | 4.50 (0.548) | U = 80.5, z = 2.142, p = 0.077 | |
Support | |||||
My need for help was recognized. | 3.67 (0.816) | 4.33 (0.516) | 4.33 (0.516) | U = 60, z = 0.468, p = 0.721 | |
I felt supported by the teacher’s assistance during the session. | 3.83 (0.983) | 4.17 (0.753) | 4.17 (0.753) | U = 65.5, z = 0.853, p = 0.454 | |
Problem-solving | |||||
Independent problem-solving was facilitated. | 3.67 (1.033) | 3.67 (0.516) | 4.33 (0.816) | U = 80, z = 1.922, p = 0.090 | |
Feedback | |||||
Feedback provided was constructive. | 3.83 (0.753) | 3.83 (0.408) | 4.00 (0.894) | U = 74, z = 1.459, p = 0.199 | |
Feedback was provided in a timely manner. | 3.83 (0.983) | 3.83 (0.408) | 3.83 (0.753) | U = 74.5, z = 1.551, p = 0.177 | |
The session allowed me to analyze my own behavior and actions. | 3.5 (1.049) | 4.00 (0.632) | 4.33 (0.816) | U = 66.5, z = 0.905, p = 0.415 | |
There are enough opportunities in the session to find out if I clearly understand the material. | 3.17 (1.169) | 3.50 (0.837) | 4.00 (0.632) | U = 71, z = 1.245, p = 0.280 | |
Learning outcomes | |||||
Adapted from the NLN Student Satisfaction and Self-Confidence in Learning scales (NLN 2005) | |||||
Satisfaction with learning | |||||
The teaching methods used were helpful and effective. | 4.00 (0.632) | 4.83 (0.408) | 4.50 (0.548) | U = 42, z = −0.979, p = 0.454 | |
I enjoyed how the teacher taught the session. | 3.50 (1.225) | 4.67 (0.516) | 4.67 (0.516) | U = 47, z = −0.539, p = 0.673 | |
Self-confidence in learning | |||||
I am confident that I am developing the skills and obtaining the knowledge needed to understand this procedure. | 3.17 (1.169) | 4.17 (0.408) | 4.33 (0.516) | U = 54.5, z = 0.044, p = 0.965 | |
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Jewer, J., Dubrowski, A., Dunne, C., Hoover, K., Smith, A., Parsons, M. (2020). Piloting a Mobile Tele-simulation Unit to Train Rural and Remote Emergency Healthcare Providers. In: Wickramasinghe, N., Bodendorf, F. (eds) Delivering Superior Health and Wellness Management with IoT and Analytics. Healthcare Delivery in the Information Age. Springer, Cham. https://doi.org/10.1007/978-3-030-17347-0_2
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