JMIR Publications

ABSTRACT

Background:

Simulated programmes provide healthcare professionals (HCPs) with a learning opportunity to develop clinical competencies and improve patient outcomes in a safe and controlled environment. While the benefits of simulation training are well-established, there is a paucity of research assessing its differential impact, if any. SIMBA (Simulation via Instant Messaging - Birmingham Advance) provides simulation-based learning through WhatsApp® and Zoom® to increase HCPs’ confidence in managing various medical conditions.

Objective:

To explore if there are differences in the clinical performance of HCPs participating in SIMBA sessions based on gender, country of work and training grade.

Methods:

This study assessed participants in 17 SIMBA sessions from May 2020 to June 2022. WhatsApp® chats containing participants' approach to the simulated scenarios were graded using an adopted version of global rating scale consisting of six domains: eliciting history; physical examination; investigations, diagnostic tests and imaging; interpretation of investigations and imaging; clinical judgement; management and follow-up/discharge plan). These domains were rated using a Likert-type scale of 1 (not done) to 5 (excellent) prior to the session based on expert inputs. All Whatsapp transcripts were evaluated against the scale post- simulation session. Unadjusted and adjusted means and 95% confidence intervals (CI) of the scores for the six performance variables were calculated using multiple linear regression models. The p-value for heterogeneity between the mean performance scores was calculated using likelihood ratio tests by using an ANOVA.

Results:

289 participants across 49 countries who completed pre- and post-SIMBA surveys in the 17 simulation sessions were included in the analysis. Participants from HICs scored higher in all categories of the GRS except the physical exam and interpretation score. Junior grade participants scored significantly higher in history taking (junior = 4.2, middle = 3.7, senior = 3.7; p=0.003) and physical examination (junior = 4.0, middle = 3.7, senior = 3.5; p=0.068), but this was not significantly different. There were no statistically significant differences in GRS scores between males and females.

Conclusions:

The significant differences in clinical performance scores between LMICs and HICs highlight the need for better medical education resources to bridge existing gaps in healthcare globally. The decrease in some clinical competency scores following career progression could be addressed by simulation-based training to maintain the same quality of history-taking and physical examination skills. These outcomes, including no gendered differences in simulation-based learning, hold profound implications for tailoring medical education strategies, fostering equitable training, and elevating patient care standards on a global scale. The need for targeted interventions and capacity-building efforts via context-specific training and tailored approaches to healthcare education are emphasised.