Healthcare Service Project Toolkit

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All of the below information should be based on local identified need. It should also be done in cooperation with local folks/ agencies/ governments, etc. It usually is not a good idea to just show up with stuff and services that might not be needed, ineffective, or even harmful in the short or long term. So based on that premise here are some items for consideration.

Types of Projects

Local Provider Education

  • Many different mission groups do this.
    • Examples:
      • Provider dialogue: 2018 ASELSI mission team form University of Missouri. Met with local rural providers for ½ day session. Asked for input from them regarding issues they deal with daily and provided input for treatment options.
  • Benefits:
    • US providers and local providers develop relationships and trust
    • US providers learn that local providers are very knowledgeable regarding diagnosis and treatment of local conditions
    • US and local providers learn from each other. Learning is a 2 way dialogue, not a one way traditional lecture-student format
  • Challenges:
    • US provider input provides tips often already known to local providers
    • Local resource limitations, especially in remote areas, limit the utility of US recommendations (no electricity, refrigeration, communication, etc.

Sustainable community development

In this model multiple mission trips are used to identify, address, and continue to work toward meeting a long term goal in a community. This allows multiple short term mission trips to work together to meet a sustainable goal in a community.

  • Benefits:
    • Needs assessment identifying a need to be met, with the input of the local community builds relationships and trust
    • Continued work on a sustained goal involving the community
    • Local and US missionaries can see fruits of their labor
    • Long term partnership and trusting relationship develops
    • May be able to provide chronic care, not just episodic
    • Better opportunity to provide ongoing education to the community and training to local providers
    • Project may help eliminate issues adversely affecting the health of the community
  • Challenges:
    • Commitment from local community for long term project
    • Commitment from multiple US mission teams
    • Requires year round participation from US teams
    • Requires long term commitment
  • Reference: Fam Med 2007;39(9):644-50

Short term medical missions

  • Multiple groups and organizations do this. Short term means anything under 1 year. Mostly 1-2 weeks.
  • Benefits:
    • Provides episodic care to low resource population
    • Provides US teams contact with a different culture
    • Allows US providers to experience low resource environments
    • Allows Local population to access US medical care episodically
    • Can provide some sustainable benefit in terms of durable medical equipment such as eyeglasses, dental repair, surgeries
  • Challenges:
    • Lack of familiarity with local culture by US providers
    • Lack of sustainable benefit
    • Potential for harm:
      • Creating dependency
      • Care delivered can be below the standard of US care
      • Focus on short term fixes, not long term solutions
      • Costly
      • Resource allocation-could money spent in travel for a team for a week be better used in the country visited?
  • Reference: Missiology: An International Review, Vol. XXXIV, no. 4, October


Lessons Learned from Experience

What to do

  • Cultural preparation: Develop familiarity with the culture visited. This includes:
    • Language
    • Appropriate Dress
    • Interpersonal relationships: appropriate greetings, gestures, interactions with members of the same and opposite sex

Local healthcare system-available resources, medications, providers, in general how the system works.

    • Local Providers: develop relationships with local providers, local healthcare systems before the first team arrives
    • Local attitudes regarding “traditional” or “western” healthcare and how it is used, accessed, or viewed in the region to be served
  • Economic preparation: Consider allocation of resources
    • Would money be better spent in country? (Bringing in meds and supplies versus local purchase)
    • Would money be better spent on something else? (Hiring a full time nurse, pharmacist, doctor, etc)
  • Identify goals
    • Short term
    • Long term
    • Sustainable project
  • Clinical/Medical
    • Use the same level of clinical skill that you would use in the US
    • Be sure those you serve are able to understand all of the instructions given regarding medications and other treatments you prescribe
    • If possible arrange local follow up for patients you see so that they will be able to have ongoing care after you leave.


What not to do:

  • Cultural:
    • DO NOT Assume that the US has all of the answers
    • DO NOT Assume that anything you do is better than what they are getting now
    • DO NOT Assume lack of knowledge about medical issues
    • DO NOT Assume lack of knowledge about public health issues
    • DO NOT Assume lack of intelligence simply because there may be a language barrier
    • DO NOT Assume US standards of behavior and relationships are acceptable globally
  • Economically:
    • DO NOT Offer to give gifts or cash to local residents unless cleared to do so by mission or local organization
  • Medical
    • DO NOT assume follow up is available
    • DO NOT assume there are adequate storage facilities for medications-there may not be
    • DO NOT assume availability of ambulance or EMS if patient gets worse-there may not be.
    • DO NOT assume understanding of instructions if given in a rushed or loud environment. Take the time to be sure patients understand meds, etc.

Specific low cost tools

Task trainers

  • Usually most cost effective.
  • Be sure that there is a need and the resources for effective training.
    • No need to take a Resusci Annie if there is no ambulance, no trained provider, no AED, and a 2 hour ride to the hospital where there may not be a defibrillator.
  • Best to focus on things that can be done locally.
  • Ideal items in my experience:
    • Suture trainers
      • can use simulated skin form other resources like chest tube trainers that are no longer useful. This provides a skill that can be used locally
    • Wound care trainers
      • burns, etc. Same as above. Provide a skill that can be used
    • Birthing trainer
      • lots of out of hospital deliveries in low resource environments. This is a needed skill
    • Demonstrating making hydration solution-dehydration is prevalent
    • IV trainers-some placed may have access to iv fluids. Good skill to learn

Toolkit Workshop

Sim for Global Healthcare Clinical Experiences

Learning Objectives

  • Develop & deliver simulation-based training modules that prepare students for short term global health experiences in low-resource environments, with an emphasis on cultural competence, team leadership, communication, and other non-technical skills.
  • Discuss and identify areas for development within the current state of research concerning the impact of simulation in interprofessoinal service-based learning.
  • Participate in the emerging community of practice among global health providers to promote effective, scaleable and sustainable global healthcare clinical experiences.

Course Overview

As healthcare students transition from the classroom to clinics and communities, interpersonal, inter-professional, and inter-cultural skills become as important as the technical skills of their professions. A powerful service-learning experience that many students and providers engage in are short-term global healthcare clinical experiences. The quality of their learning can be enhanced through the use of pre-departure simulation training.

Course Description

As healthcare students transition from the classroom to clinics and communities, interpersonal, inter-professional, and inter-cultural skills become as important as the technical skills of their professions. They must be able to apply their knowledge as members of interprofessional teams working in culturally diverse populations. In order to be successful, learners must develop non-technical skills such as leadership, communication, ethical decision making, and cultural sensitivity. These skills are best taught through direct experience combined with reflective practice (1-5). One form of experiential education known to be particularly effective in the development of these “soft skills” is that of service-learning (6-9).

Many healthcare students and providers participate in global healthcare clinical experiences, which have the potential to be powerful service-learning experiences. Learning opportunities, however, may be limited by lack of adequate preparation for the full scope of ethical and cultural differences learners may encounter (10-18). Research shows that pre-departure training improves the quality of the clinical experience, but there is a decided lack of resources available on how to best develop and deliver these preparatory experiences (19-21). The workshop faculty have multiple years of experience leading international service learning projects and have used simulation-based education to enhance pre-departure training. As a part of this workshop, participants will actively develop and practice simulations to create safe and effective pre-departure training for learners participating in global healthcare clinical experiences .

As with any program, it is important to know that simulation is effective as a pre-departure training modality, and to identify key elements needed for sustainability, scalability, and effectiveness. This workshop will provide an overview of the current state of research in this field, explore the opportunities and barriers that exist in this application of simulation-based education, and explore how to best develop research regarding this type of short-term high-value experiences. The workshop will encourage participants to join the emerging community of practitioners that are creating effective training for anyone participating in global health clinical experiences.

Instructional Timeline

  • If workshop is a 4-hour precon:
    • Introductions (10 min)
      • Workshop logisitcs
      • Intro of each faculty with basics of global healthcare experience
      • Disclosures
    • Overview of Service Learning & it’s role in Healthcare Missions (20 min)
      • Presentation format
      • setting the context and scope of the workshop
      • Gives sense of state the research
      • Faculty give very brief overview of their programs and research
    • Group activity: Pre-departure simulation of a healthcare service-learning experience. (40 min)
      • Depending on number of participants, either all will particate in a mini-sim or more likely, there will be a few active participants and many observing participants.
    • 20 minute simulation
    • 20 minute debriefing
    • Facilitated whole-group discussion (30 min)
    • Facilitated discussion of all workshop participants
      • Used to identify specific ways that simulation can enhance healthcare missions
      • Used to identify topics for break-out groups and projects.
    • Break (10 min)
    • Panel Presentation of Current Projects (10 minutes each = 40 minutes)
    • Break-out Groups: Developing Pre-departure Simulations with Research Components (30 minutes)
      • Each group develops a quick simulation for pre-departure
    • Facilitated Report-back from Break-out Groups (30 minutes)
      • Each group presents and entertains discussion about there simulation
      • Reform new groups based on common interests
    • Break-out Groups: Expand Simulations to include Research (20 minutes)
      • Each new group develops a research protocol to support that simulation
    • Whole Group Discussion about next steps, development of community, and implementation of these ideas.(20 min)
    • Q & A (10 min)
  • If a 90 minute workshop,
    • Introductions (including) (5 min)
      • Workshop logistics
      • Intro of each faculty with basics of global healthcare experience
      • Disclosures
    • Overview of Service Learning & its role in Short Term Global Health Clinical Experiences (15 min)
      • Presentation format
      • setting the context and scope of the workshop
      • Gives sense of state the research
      • Faculty give very brief overview of their programs and research
    • Group activity: Pre-departure simulation of a healthcare service-learning experience. (60 min)
    • Depending on number of participants, either all will participate in a mini-sim or more likely, there will be a few active participants and many observing participants.
    • 15 minute simulation
    • 15 minute debriefing
    • Q & A (10 min)

References

  • Ryan-Krause P. Short-term Global Experiences: Reflections, Themes, and Implications. J Nurs Educ 2016 Jul 1;55(7):379-384.
  • Wagner LD, Christensen SE. Establishment of a short-term global health nursing education experience: impact on students’ ways of knowing. J Nurs Educ 2015 May; 54(5):295-9.
  • Rapp DE. Integrating cultural competency into the undergraduate medical curriculum. Med Educ 2006;40(7):704-710.
  • Kristen Jogerst, Brian Callender, Virginia Adams, Jessica Evert, Elise Fields, Thomas Hall, Jody Olsen, Virginia Rowthorn, Sharon Rudy, Jiabin Shen, Lisa Simon, Herica Torres, Anvar Velji, Lynda L. Wilson, Identifying Interprofessional Global Health Competencies for 21st-Century Health Professionals, Annals of Global Health,Volume 81, Issue 2, 2015, 239-247.

Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. J Healthcare Poor Underserved 1998:9(2):117-125.

  • Glickman LB, Olsen J, Rowthorn V. Measuring the cross-cultural adaptability of a graduate student team from a global immersion experience. J Cult Divers 2015;22(4):148-154.
  • Hayward LM, Charrette AL. Integrating cultural competence and core values: an international service-learning model. J Phys Ther Educ 2012;26(1):78-89.
  • Ekelman B, Dal Bello-Haus V, Bazyk J, Bazyk S. Developing Cultural Competency in Occupational Therapy and Physical Therapy Education: A Field Immersion Approach. J Allied Health 2003;32(2):131-37.
  • Mu K, Peck K, Jensen L, Bracciano A, Carrico C, Feldhacker D. CHIP: Facilitating Interprofessional and Culturally Competent Patient Care Through Experiential Learning in China. Occupational Therapy International 2016;23(4):328-337.
  • Logar T, Le P, Harrison JD, et al. Teaching corner: “first do no harm”: teaching global health ethics to medical trainees through experiential learning. J Bioeth Inq 2015;12(1):69-78.
  • Crump JA, Sugarman J. Ethical considerations for short-term experiences by trainees in global health. The Journal of the American Medical Association 2008; 300(12):1456-1458
  • Crump JA, Sugarman J, and Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. The American Journal of Tropical Medicine and Hygiene 2010; 83(6): 1178-1182.
  • Reisch RA. International service learning programs: Ethical issues and recommendations. Developing World Bioethics 2011; 11(2):93-98.
  • Landry MD, Nixon S, Raman S, et al. Global health experiences (GHEs) in physical therapist education: balancing moral imperatives with inherent moral hazard. JOPTE 2012;26(1):24-29.
  • Dasco M, Chandra A, Friedman H. Adopting an ethical approach to global health training: the evolution of the Botswana-University of Pennsylvania partnership. Acad Med 2013;88(11):1646-1650.
  • Elit L, Hunt M, Redwood-Campbell L, et al. Ethical issues encountered by medical students during international health electives. Med Educ 2011;45(7):704-11.
  • Lattanzi JB, Pechak C. A conceptual framework for international service-learning course planning: promoting a foundation for ethical practice in the physical therapy and occupational therapy professions. J Allied Health 2011;40(2):103-9.

DeCamp M, Lehmann LS, Jaeel P, Horwitch C, for the ACP Ethics, Professionalism and Human Rights Committee. Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper. Ann Intern Med 2018;168:651–657. Bessette J, Camden C. Pre-departure training for student global health experiences: A scoping review. Physiotherapy Canada 2016; ahead of print article; doi:10.3138/ptc.2015-86GH. Accessed May 10, 2017.

  • Wallace LJ, Webb A. Pre-departure Training and the Social Accountability of International Medical Electives. Educ for Health 2014;27(2):143-147.
  • Anderson K, Bocking N, et al. Preparing Medical Students for Electives in Low-Resource Settings: A Template for National Guidelines for Pre-Departure Training. AFMC Global Health Resource Group and CFMS Global Health Program. May 2008.