Rural Health Care Workers Being Reached with Simulation Training
By Sherri Boisvert PhD, MSN, RN
Simulation Outreach Network (SON)
VHA SimLEARN National Simulation Center
ORLANDO, Fla. – One of the top priorities discussed by VA Secretary Robert Wilkie during his confirmation hearing was accessibility and quality of care provided to rural Veterans. Rural Veterans may be 600 miles from the nearest Veterans Affairs medical center, impeding their access and quality of care. Community Based Outpatient Clinics (CBOC) were established to accommodate this access. However there still exists the problem of qualified, trained health care workers to provide care in these remote areas.
Understanding the challenge of educating clinicians serving rural Veterans, the Office of Rural Health and SimLEARN collaborated in a workforce development project to address these challenges. The project’s overarching goal was to expand the development of simulation-based health care training programs in VA rural-based facilitates.
Six rural facilities were chosen to participate; each with their own unique perspective. Each participating site brought innovative project strategies to achieve the overarching goal of improving Veteran outcomes. Three simulation strategies were developed successfully to assist in reducing or eliminating the existing barriers to training clinicians in the rural areas. This includes personnel, time and space. The first strategy was educating Veterans and families to administer Naloxone through train-the-trainer simulations conducted at CBOC locations. The second was using technology for simulation, including virtual delivery for providers improved access to care for CBOC patients requiring shoulder and knee injections. The third strategy was the development of short, focused simulations related to common conditions found in rural health Veteran populations. This reached the clinicians, who ultimately influence improving the quality of care to the Veterans. (https://www.inacsl.org/inacsl-standards-of-best-practice-simulation/, n.d.).
The participating sites applied a framework of collaboration and networking to achieve their goal. Four key elements to successful networking included the establishment of a multidisciplinary simulation advisory board, leadership briefings, a rural health simulation training and simulation workshops. Advisory boards met quarterly and conducted annual simulation education needs assessments, including rural sites to identify simulation educational priorities. Advisory board meetings also provided an opportunity to share ongoing simulation knowledge gained from workshops, conferences and webinars. Workshops were held to ensure that all those providing simulation training had a foundational knowledge of simulation. Workshops provided participants an opportunity to collaboratively develop simulation-based activities to support priority training needs that utilize existing resources or that can be created inexpensively (Bangejee, A, Slagle M. J, Mercaldo D. N, Booker,R, Miller, A, France J. D, Rawn L, Weinger B. M, 2016).
Outcomes were measured both quantitatively and qualitatively. Qualitatively, the number of trained individuals at the sites was 6,537. The numbers included 5,029 clinicians, 1,084 staff, and 424 Veterans in 41 rural facilities who were trained utilizing simulation from January 2017 thru October 2019. The impact of the project for the health care worker was determined through collecting “Kirkpatrick Level,” 1, 2 and 3 data. Data was collected immediately following training and 90-days post training. The results of the data indicated providing in situ simulation experiences to health care workers in rural areas optimizes patient access and quality of care. This is accomplished by listening and respecting the voices from the field, leveraging simulation technology in CBOCs to creatively meet training needs, improving assessment skills and self-confidence, as well as building relationships to successfully overcome barriers.
Bangejee, A, Slagle M. J, Mercaldo D. N, Booker,R, Miller, A, France J. D, Rawn L, Weinger B. M. (2016). A simulation-based curriculum to introduce key teamwork principles to entering medical students. BioMed Central Medical Education, 296-308.