Enhancing trauma care through innovative trauma and disaster team response training: A blended learning approach in Tanzania.

BACKGROUND: In Tanzania, inadequate infrastructures and shortages of trauma-response training exacerbate trauma-related fatalities. McGill University's Centre for Global Surgery introduced the Trauma and Disaster Team Response course (TDTR) to address these challenges. This study assesses the impact of simulation-based TDTR training on care providers' knowledge/skills and healthcare processes to enhance patient outcomes. METHODS: The study used a pre-post-interventional design. TDTR, led by Tanzanian instructors at Muhimbili Orthopedic Institute from August 16-18, 2023, involved 22 participants in blended online and in-person approaches with simulated skills sessions. Validated tools assessed participants' knowledge/skills and teamwork pre/post-interventions, alongside feedback surveys. Outcome measures included evaluating 24-h emergency department patient arrival-to-care time pre-/post-TDTR interventions, analyzed using parametric and non-parametric tests based on data distributions. RESULTS: Participants' self-assessment skills significantly improved (median increase from 34 to 58, p < 0.001), along with teamwork (median increase from 44.5 to 87.5, p < 0.003). While 99% of participants expressed satisfaction with TDTR meeting their expectations, 97% were interested in teaching future sessions. The six-month post-intervention arrival-to-care time significantly decreased from 29 to 13 min, indicating a 55.17% improvement (p < 0.004). The intervention led to fewer ward admissions (35.26% from 51.67%) and more directed to operating theaters (29.83% from 16.85%), suggesting improved patient management (p < 0.018). CONCLUSION: The study confirmed surgical skills training effectiveness in Tanzanian settings, highlighting TDTR's role in improving teamwork and healthcare processes that enhanced patient outcomes. To sustain progress and empower independent trauma educators, ongoing refresher sessions and expanding TDTR across low- and middle-income countries are recommended to align with global surgery goals.

Examining perception and actual knowledge change among learners in a standardized burn course.

BACKGROUND: Essential Burn Management (EBM) is a burn training program created for East Africa and aims to meet the needs of low- and middle-income countries. The authors present a report on objective testing of change in knowledge, with pre and post tests, and comparison of this testing with the self perception of knowledge gained to explore course utility. OBJECTIVE: To evaluate the ability of EBM to improve knowledge in burn care among course participants; and to explore whether participants' self-perception of knowledge gained is comparable with their actual change in knowledge. METHODS: Twenty health care providers from a variety of disciplines participated in EBM and completed the pre and post course burn care knowledge test. Participants also self-rated knowledge in burn care both pre and post course. All tests and self-rated assessments were anonymous and consent was obtained. Paired t tests were conducted on pre and post test scores. Improvements in pre-post scores according to module or topic area were examined to determine the proportion correct, and then analyzed using Wilcoxon signed-rank tests. Module scores pre-post course were compared with individuals' self-rating of knowledge both before and after the course for that particular module. RESULTS: Pre-post course tests reflected an increase in knowledge. An increase in self-rated knowledge was matched with a significant increase in module test scores for primary survey, burn resuscitation, wound management, infection control and electrical injury, but not inhalation injury and compartment syndrome modules. CONCLUSION: Findings support a combination of self-report and objective pre-post testing to evaluate courses designed to teach burn management.

HISTORIQUE: La gestion essentielle des brûlures (GEB) est un programme de formation sur les brûlures créé pour l'Afrique de l'Est afin de répondre aux besoins des pays à faible et moyen revenu. Les auteurs présentent un rapport sur les tests objectifs d'acquisition des connaissances, au moyen de tests avant-après, et les comparent aux perceptions des connaissances acquises pour explorer l'utilité du cours. OBJECTIF: Évaluer la capacité de la GEB à améliorer les connaissances des participants au cours sur les soins des brûlures et explorer si les perceptions des connaissances qu'ils ont acquises sont comparables au véritable changement de connaissances. MÉTHODOLOGIE: Vingt dispensateurs de soins de diverses disciplines ont participé à la GEB et effectué le test avant-après sur les connaissances des brûlures. Les participants ont également autoévalué leurs connaissances sur les soins des brûlures avant et après le cours. Les tests et les autoévaluations étaient tous anonymes, et les participants avaient donné leur consentement. Les cher-cheurs ont effectué des tests t d'échantillons appariés sur les scores aux tests avant-après. Ils ont examiné les améliorations aux scores avant-après selon le module ou le sujet pour déterminer la proportion de bons résultats, puis les ont analyséses selon les tests d'appariement des données de Wilcoxon. Ils ont comparé les scores des modules avant-après à l'autoévaluation des connaissances avant et après le cours pour chaque module. RÉSULTATS: Les tests avant-après reflètent une augmentation des connaissances. Une augmentation des connaissances autoévaluées correspondait à un accroissement important des points accumulés lors des tests des modules sur l'évaluation primaire, la réanimation des brûlés, le traitement des plaies, le contrôle des infections et les blessures électriques, mais pas de ceux sur les blessures par inhalation et le syndrome des loges. CONCLUSION: Les observations appuient une combinaison d'autodéclaration et de tests avant-après objectifs pour évaluer les cours sur la gestion des brûlures.

Creation of a standardized burn course for Low Income Countries: meeting local needs.

INTRODUCTION: Standardized courses for the care of the burn patient have historically been developed in High Income Countries (HIC). These courses do not necessarily reflect the challenges and needs of Low Income Countries (LIC) and some components may not be relevant there (i.e. use of ventilators in a country that has no or very limited number of ventilators). We are developing a Burn Management Course for East Africa. This course was created and trialed in a LIC and subsequently a formal manual and course curriculum created. Recently the first iteration of the course was undertaken in a major regional burn centre in East Africa. We present participant feedback on the course content, and potential future directions for course development. OBJECTIVE: (1) To evaluate the ability of a standardized burn course for LIC to meet the needs of the participants. (2) To explore characteristics of burn care and needs related to delivery of burn care in LIC. METHODS: 21 students participated in a multidisciplinary burn management course. They were asked to complete an anonymous questionnaire at the end of the course. RESULTS: There were 11 nurses, 6 doctors, a physiotherapist, occupational therapist, and a dietician. 15 worked in either the adult or pediatric burn units, the other six worked in emergency, ICU or the operating room. The majority of respondents (56%) had less than 3 years of experience working with burn patients. Overall agreement that the course met their objectives was rated as 4.6 out of 5. As well the students agreement that they had a better understanding of burn injury was rated as 4.8/5. 55.6% indicated that scalds were the most commonly seen injury followed by 27.8% responding that flames were the most common. Some responses to the question of top difficulties facing the caregivers were similar to HIC: staffing shortages, bed shortages, and finding useable donor site in large burns. Other responses highlighted the challenges these care givers face: poverty stricken patients, not enough appropriate food available, and deficiencies in infection control practices. CONCLUSION: It is possible to create a course that translates knowledge from a HIC setting to meet the needs of the end-user in a LIC setting.