Dr Claudine explaining basic resuscitation skills
Background
In a collaboration between Initiative for Medical Equity and Global Health (IMEGH) and la Croix du Sud Hospital, BLS and ACLS courses were conducted in order to train and reinforce essential clinical skills and non-technical skills for hospital staff including medical doctors, nurses, midwives and paramedical staff (laboratory, ophthalmology technician and mental health officers). The courses contents are based on common challenging situations found in the low resource and private health facilities.
The facilitators utilized active teaching methodologies including online courses, group discussion and low-cost simulation. The clinical focus was on resuscitative techniques and common clinical scenarios.
BLS and ACLS courses are delivered based on the recent American Heart Association guidelines. Participants are encouraged to use teamwork and decision making to solve problems using the typical resources found in their hospital.
This model of combining online and in-person practical sessions aims 1) to use technology and deliver efficient and effective resuscitation training, 2) to improve performance of resuscitation teams working in healthcare facilities, and 3) to meet the MOH accreditation requirements as detailed in the critical standards in risk area II.
Course Facilitators
Felix NDUHUYE, Nurse/Public Health Specialist, Course coordinator
Dr Claudine Uzamukunda, Anesthesiologist, Instructor
Dr Remy Steve MBAHIRE, Anesthesiologist, Instructor
Dr Isaac NDAYISHIMIYE, Anesthesia Resident, Facilitator
Dr Eugene Tuyishime, Anesthesiologist/Global Health Expert, Course Director
Course conduct
Participants practicing essential CPR skills
The BLS and ACLS training was conducted in two parts. The first one was an online course from 10th-17th (BLS) and 19th – 24th (ACLS) and the second part was more practical conducted on 18th August, 2023 for BLS and 25th August 2023 for ACLS.
There are unique challenges faced while conducting these courses, however, appropriate strategies were put in place to ensure successful training:
Language barrier: Some participants were more comfortable in Kinyarwanda and French with limited level of English. As a solution, most of the training was conducted in Kinyarwanda with slides in English. In addition, participants were allowed to ask questions and to express themselves in different languages (Kinyarwanda, French and English). This contributed to better comprehension and satisfaction as well as active participation.
Familiarity with simulation: As most of participants had no prior experience with simulation, the team organized a detailed orientation and allowed enough time for questions. The preparation time and explanation for role play was increased before starting each scenario. In addition, during debriefing there was time for micro-teaching and answering clinical questions as appropriate.
Choice of participants: There were no non-clinical staff for BLS course.
Time management: There were conflicting agenda of the participants and time dedicated to the course especially during BLS session. To overcome this issue, we opt to omit all intermediate breaks which allowed the participants to be efficient despite conducting multiple activities simultaneously.
The situation has been improved during the ACLS practical session. We appreciate the administration support which allowed great participation and made sure clinical leaders were available to deliver certificates.
Summary of participant evaluations
The participants found the courses valuable and expressed their satisfaction. There was a high level of engagement and motivation to acquire more new knowledge from the BLS and ACLS courses and to prepare other sessions for the rest of every clinical staff in the hospital. The amount of the course content was at times overwhelming. Participants requested continuous training (refresher courses).
Participants recognized the essential need to create a safe space for learners, including attention to putting materials into Kinyarwanda and allowing time for thinking during scenarios.
Participants expressed that it would have been helpful to keep the mannequins used during the training at their hospital and have more time to practice for lifelong learning of simulation skills. We will discuss with the administration to evaluate the feasibility of this suggestion.