Ethics Simulation in Global Health Training (ESIGHT).
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ABSTRACT:
SUBMITTER: Asao S
PROVIDER: S-EPMC6338194 | biostudies-literature | 2017 Jun
REPOSITORIES: biostudies-literature
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Project description:BackgroundInterest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues.MethodsWe developed and evaluated an introductory curriculum, "Ethical Challenges in Short-term Global Health Training." The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum.ResultsThe ten case curriculum is freely available at http://ethicsandglobalhealth.org. An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably.ConclusionsThe curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.
| S-EPMC3598721 | biostudies-literature
Project description:To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, offering safe and mentored international rotations, and creating GH experiences that are of service to resource-limiting settings. Academic GH partnerships allow for the opportunity to collaborate on education and research and improve health care and health systems, but must ensure mutual benefit to U.S. and international partners. This article provides guidance for incorporating GH education into U.S. residency programs in an ethically sound and sustainable manner, and gives examples and solutions for common challenges encountered when developing GH education programs.
| S-EPMC5400750 | biostudies-literature
Project description:Global health security (GHS) is dependent upon having an adequate and prepared health security workforce. There are currently numerous challenges in establishing and maintaining a health security workforce. The frequency and magnitude of disasters have increased significantly over the past 30 years. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging GHS threats. Developing and maintaining GHS -specific skills in the healthcare workforce is a tremendous logistical challenge. Innovative education technologies, including simulation and digital learning, can be leveraged to achieve preparedness for GHS threats. This chapter focuses on the application of modeling and simulation to support Global Health Security planning, preparedness and operations.
| S-EPMC7123972 | biostudies-literature
Project description:BackgroundThe field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity.MethodsThis paper provides a critical interpretive review of how the term "global health ethics" has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally.ResultsSelected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles (88%) were written by authors in high-income countries (HIC), as defined by the World Bank country classifications, 8 articles (5%) were written by authors in low- or middle-income countries (LMIC), and 13 articles (7%) were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics (n = 10), Developing World Bioethics (n = 9), and Bioethics (n = 7). We coded the articles by level of engagement within the ethical domain at different levels: (1) interpersonal, (2) institutional, (3) international, and (4) structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks.ConclusionsThis critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship.
| S-EPMC6657376 | biostudies-literature
Project description:IntroductionAt Brigham and Women's Hospital, we identified the need for a comprehensive training program designed to prepare frontline staff to safely manage a patient with Ebola viral disease (EVD). The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD.MethodsWe delivered a 4-hour experiential training program to frontline health care professionals who would be expected to care for a patient with EVD. The program occurred in a simulation center with multiple flexible spaces and consisted of demonstration, multiple skills practice sessions, and a patient simulation case. We analyzed completed pre- and posttraining questionnaires. The questionnaire assessed their subjective level of confidence in three key areas: donning and doffing PPE, performing clinical skills while wearing PPE, and management of a contamination breach.ResultsThis program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. Our intervention significantly increased the confidence of participants on each primary objective (p = .001 for all three stations).DiscussionThis interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Our intent is that the skills taught in this training program would also be transferable to management of other infectious diseases in the clinical setting.
| S-EPMC6354722 | biostudies-literature
Project description:BackgroundMolding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum.MethodsWith a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review.ResultsThe first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF).ConclusionsOur systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.
| S-EPMC8188952 | biostudies-literature
Project description:Introduction. As more trainees engage in global health electives, the call for best practices in predeparture preparation grows. However, many residency programs may not have the infrastructure or staffing in place to consistently meet these expectations. Objective. To assess the feasibility, benefits, and limitations of having residents trained to facilitate and implement a global health preparatory simulation curriculum. Approach. In 2016, we had 5 residents undergo online Simulation Use for Global Away Rotations (SUGAR) facilitator training. Since then, we have conducted 3 simulation sessions from 2016 to 2018. Feedback was obtained from 75% of our participants, which was found to be similar to feedback obtained from attending-led models. Lessons Learned. A resident-led global health preparatory curriculum provides a sustainable model for residency programs without placing additional burden on attending faculty.
| S-EPMC6537236 | biostudies-literature
Project description:BackgroundThe governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health.MethodsWe undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks.ResultsConsequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities.ConclusionsDespite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.
| S-EPMC3464702 | biostudies-literature
Project description:BackgroundSimulation based medical education (SBME) allows learners to acquire clinical skills without exposing patients to unnecessary risk. This is especially applicable to Emergency Medicine training programs where residents are expected to demonstrate proficiency in the management of time critical, low frequency, and highly-morbidity conditions. This study aims to describe the process through which a SBME curriculum was created, in a limited simulation resource setting at a 4-year Emergency Medicine (EM) residency program at the American University of Beirut Medical Center.MethodsA case-based pilot simulation curriculum was developed following Kern's 6 step approach to curriculum design. The curricular objectives were identified through an anonymous survey of the program's residents and faculty. Curriculum outcomes were assessed, and the curriculum was revised to address curricular barriers. Evaluations of the revised curriculum were collected during the simulation sessions and through a whole revised curriculum evaluation at the end of the first year of its implementation.Results14/20 residents (70%) and 8/8 faculty (100%) completed the needs assessment from which objectives for the pilot curriculum were developed and implemented through 6 2-h sessions over a 1-year period. Objectives were not met and identified barriers included cost, scheduling, resources, and limited faculty time. The revised curriculum addressed these barriers and 24 40-min sessions were successfully conducted during the following year. The sessions took place 3 at a time, in 2-h slots, using the same scenario to meet the objectives of the different learners' levels. 91/91 evaluations were collected from participants with overall positive results. The main differences between the pilot and the revised curricula included: a better understanding of the simulation center resources and faculty's capabilities.ConclusionSimulation-based education is feasible even with limited-resources. However, understanding the resources available, and advocating for protected educator time are essential to implementing a successful EM simulation curriculum.
| S-EPMC7792073 | biostudies-literature
Project description:IntroductionEffective electronic health record (EHR)-based training interventions facilitate improved EHR use for healthcare providers. One such training intervention is simulation-based training that emphasises learning actual tasks through experimentation in a risk-free environment without negative patient outcomes. EHR-specific simulation-based training can be employed to improve EHR use, thereby enhancing healthcare providers' skills and behaviours. Despite the potential advantages of this type of training, no study has identified and mapped the available evidence. To fill that gap, this scoping review will synthesise the current state of literature on EHR simulation-based training.Methods and analysisThe Arksey and O'Malley methodological framework will be employed. Three databases (PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature) will be searched for published articles. ProQuest and Google Scholar will be searched to identify unpublished articles. Databases will be searched from inception to 29 January 2020. Only articles written in English, randomised control trials, cohort studies, cross-sectional studies and case-control studies will be considered for inclusion. Two reviewers will independently screen titles and abstracts against inclusion and exclusion criteria. Then, they will review full texts to determine articles for final inclusion. Citation chaining will be conducted to manually screen references of all included studies to identify additional studies not found by the search. A data abstraction form with relevant characteristics will be developed to help address the research question. Descriptive numerical analysis will be used to describe characteristics of included studies. Based on the extracted data, research evidence of EHR simulation-based training will be synthesised.Ethics and disseminationSince no primary data will be collected, there will be no formal ethical review. Research findings will be disseminated through publications, presentations and meetings with relevant stakeholders.
| S-EPMC7422637 | biostudies-literature