Can a tent and some mobile tech change training in rural and remote settings?

Dr Kunal D Patel 03 Oct 2019
Art by @Klimach

In regions where the health workforce is spread widely and the health needs of the population vary between rural and urban, how can we ensure health workers get further training, especially if isolated? Previous research shows what can be done in terms of innovation and tech, creating communities of practice and using simple technology to create learning bridges and increasing capacity for mentoring.

Nevertheless, a hands-on approach is sometimes needed. Simulation is increasingly being used in health education as a means of placing students in real-life scenarios and learning from them, gaining clinical skills but improving understanding around collaboration and teamwork. It also reduces the risk to patients, however, currently it is offered more in urban centres, commonly large teaching units or hospitals. So how do we help those in the rural setting? Sure, the emergence of virtual reality and more can certainly help but this does not work for all and to be fair, forms only part of the solution.

Another part is bringing simulation-based medical education to those in rural regions, physically. A team in Newfoundland, utilized mobile technology and a tent to do just that. By creating a mobile ‘telesimulation’ unit, within a rapidly deployable tent, the trainees were able to provide an environment where mentors based elsewhere could deliver simulation-based training. As you can see from the figures below, all the equipment was provided:

MTU unit and tent

image of tent equipment

Figures from Evaluation of a Mobile Telesimulation Unit to Train Rural and Remote Practitioners on High-Acuity Low-Occurrence Procedures: Pilot Randomized Controlled Trial J Med Internet Res 2019;21(8):e14587

 

69 participants were involved and clinical skills such as chest drain insertion were taught. As with all educational pilots, they were correctly assessed for their learning but also their reaction and evaluation of the experience. Learning outcomes for the participants who received training remotely through the MTU, were found to be comparable with those of the face-to-face simulation-based training group. Additionally, by using Kirkpatrick’s Learning Evaluation Model and Miller’s Clinical Assessment Framework, the authors were able to determine that satisfaction levels were high and overall the experience was positive.

Overall, though a pilot, the implications of such a model could be of real benefit for rural training but also for training in low resource or emergency settings in remote locations. Obviously, the pilot will have to be repeated and additionally, an economic evaluation will need to be done, dependent on the setting and environment. However, as the technology used is getting cheaper there is real potential for mobile telesimulation and its use in low-cost settings such as tents.