really good stuff
Global health simulations yield culturally competent medical providers
Article first published online: 18 OCT 2012
© Blackwell Publishing Ltd 2012
Volume 46, Issue 11, pages 1126–1127, November 2012
How to Cite
Parisi, V., Ahmed, Z., Lardner, D. and Cho, E. (2012), Global health simulations yield culturally competent medical providers. Medical Education, 46: 1126–1127. doi: 10.1111/medu.12012
- Issue published online: 18 OCT 2012
- Article first published online: 18 OCT 2012
What problems were addressed?
Global burdens of disease and health disparities have become increasingly apparent worldwide. As awareness has grown, global health studies have been incorporated into medical education through didactics and discussion. Fieldwork opportunities have become part of these curricula, yet there is little evidence of experiential training prior to departure.1 Individuals often enter clerkships and fieldwork without formal cultural competency training and resource management skills, which may represent an enormous disservice to both provider and patient.
What was tried?
As simulation has proven to be an effective tool for training health care professionals, the New York Institute of Technology Center for Global Health (NYIT CGH) constructed five fieldwork scenarios to link knowledge learned in its Global Health Certificate programme to practical experience. The simulation program aims to prepare participants for cultural encounters, focusing on leadership, team building and resource management.
Surveys addressing demographics, clinical and travel experience were administered prior to the simulations. Four groups of five or six individuals participated in each scenario. Each group was evaluated by trained professionals using a modified holistic rating scale. The NYIT CGH simulation program Communication Assessment Tool was developed to accommodate global health and cultural competency. It consists of five sets of competencies categorised as: (i) Rapport Building; (ii) Empathetic Approach; (iii) Professionalism/Tact; (iv) Non-Verbal Communication, and (v) Language Proficiency/Interpreter Etiquette. Each category is accompanied by specific examples of acceptable communication and actions. Marks were given on an ascending performance scale of 1–7.
Post-simulation surveys focused on participants’ perceptions of the realistic quality, utility and efficacy of global health simulations. Each question requested that a response be given on a 5-point Likert scale on which A = strongly agree, B = agree, C = neither agree nor disagree/undecided, D = disagree and E = strongly disagree.
Debriefing involved a two-fold process involving discussion and a viewing of the professionally videotaped simulations prior to departure.
What lessons were learned?
Overall, 90.1% of participants responded to the post-simulation survey; two individuals did not respond for unknown reasons. Although simulation does not replace practical experience, preliminary data demonstrated its significant utility in preparing participants for future fieldwork. Upon completing the simulations, 30.0% of individuals strongly agreed and 55.0% agreed that the scenarios had better prepared them for future fieldwork. Only 10.0% of respondents were undecided on this issue and 5.0% disagreed on the utility of the simulations.
The results also indicated that simulation has a positive impact on perceived cultural views and comfort in fieldwork settings and resource-poor environments.
Improving the realistic quality of the scenarios is imperative to increase the simulations’ efficacy. Overall, 20.0% of respondents strongly agreed and 40.0% agreed that the simulations were realistic. A further 30.0% of respondents were undecided about the realistic quality of the scenarios and 10.0% of individuals disagreed, believing that the simulations were not realistic.
The Communication Assessment Tool is currently in the validation process. The goal is to show that global health can be approached not only subjectively, but also in a systematic manner, using standardised core competencies.
The NYIT CGH simulation program, when used in combination with global health coursework, can better prepare participants for fieldwork and future clinical experiences.