Understanding the barriers and enablers for postgraduate medical trainees becoming simulation educators: a qualitative study.

introductionThere is increasing evidence that Simulation-based learning (SBL) is an effective teaching method for healthcare professionals. However, SBL requires a large number of faculty to facilitate small group sessions. Like many other African contexts, Mbarara University of Science and Technology (MUST) in Uganda has large numbers of medical students, but limited resources, including limited simulation trained teaching faculty. Postgraduate medical trainees (PGs) are often involved in clinical teaching of undergraduates. To establish sustainable SBL in undergraduate medical education (UME), the support of PGs is crucial, making it critical to understand the enablers and barriers of PGs to become simulation educators.

methodsWe used purposive sampling and conducted in-depth interviews (IDIs) with the PGs, key informant interviews (KIIs) with university staff, and focus group discussions (FGDs) with the PGs in groups of 5-10 participants. Data collection tools were developed using the Consolidated framework for implementation research (CFIR) tool. Data were analyzed using the rigorous and accelerated data reduction (RADaR) technique.

resultsWe conducted seven IDIs, seven KIIs and four focus group discussions. The barriers identified included: competing time demands, negative attitude towards transferability of simulation learning, inadequacy of medical simulation equipment, and that medical simulation facilitation is not integrated in the PGs curriculum. The enablers included: perceived benefits of medical simulation to medical students plus PGs and in-practice health personnel, favorable departmental attitude, enthusiasm of PGs to be simulation educators, and improved awareness of the duties of a simulation educator. Participants recommended sensitization of key stakeholders to simulation, training and motivation of PG educators, and evaluation of the impact of a medical simulation program that involves PGs as educators.

conclusionIn the context of a low resource setting with large undergraduate classes and limited faculty members, SBL can assist in clinical skill acquisition. Training of PGs as simulation educators should address perceived barriers and integration of SBL into UME. Involvement of departmental leadership and obtaining their approval is critical in the involvement of PGs as simulation educators.