Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

Solange Madriz; Patience Afulani; Hilary Spindler; Rakesh Ghosh; Nidhi Subramaniam; Tanmay Mahapatra; Aritra Das; Sunil Sonthalia; Aboli Gore; Susanna R Cohen; Seema Handu; Dilys Walker

doi:10.1186/s12909-022-03911-9

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

BMC Med Educ. 2022 Dec 15;22(1):869. doi: 10.1186/s12909-022-03911-9.

Authors

Affiliations

¹ Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA. solange.madriz@ucsf.edu.
² Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
³ Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA.
⁴ PRONTO International, Patna, Bihar, India.
⁵ CARE India, Patna, Bihar, India.
⁶ Department of Obstetrics and Gynecology University of Utah, Salt Lake City, UT, USA.

Abstract

Background: Simulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It's unknown if simulation facilitation skills can be adopted through a train of trainers' cascade. To fill this gap, we designed a study to evaluate the simulation and debrief knowledge, attitudes and skills of a third generation of 701 simulation educators in Bihar, India. In addition, we assessed the physical infrastructure where simulation takes place in 40 primary healthcare facilities in Bihar, India.

Methods: We performed a 1 year before-after intervention study to assess the simulation facilitation strengths and weaknesses of a cadre of 701 nurses in Bihar, India. The data included 701 pre-post knowledge and attitudes self-assessments; videos of simulations and associated debriefs conducted by 701 providers at 40 primary healthcare centers.

Results: We observed a statistically significant difference in knowledge and attitude scores before and after the 4-day PRONTO simulation educator training. The average number of participants in a simulation video was 5 participants (range 3-8). The average length of simulation videos was 10:21 minutes. The simulation educators under study, covered behavioral in 90% of debriefs and cognitive objectives were discussed in all debriefs.

Conclusion: This is the first study assessing the simulation and debrief facilitation knowledge and skills of a cadre of 701 nurses in a low-resource setting. Simulation was implemented by local nurses at 353 primary healthcare centers in Bihar, India. Primary healthcare centers have the physical infrastructure to conduct simulation training. Some simulation skills such as communication via whiteboard were widely adopted. Advanced skills such as eliciting constructive feedback without judgment require practice.

Keywords: Global Health; Health Education; Low-resource setting; Maternal and Newborn Health; Simulation; Simulation Educator.

MeSH terms

Clinical Competence
Communication
Faculty, Nursing
Humans
India
Infant Health*
Infant, Newborn
Simulation Training*