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Simulation Use for Global Away Rotations (SUGAR): Preparing Residents for Emotional Challenges Abroad—A Multicenter Study

      Abstract

      Background

      Preparation for residents participating in global health (GH) experiences is critical. Active preparatory curricula allowing residents to experience and debrief emotional challenges they may encounter abroad are generally lacking. We sought to evaluate a novel simulation curriculum designed to prepare residents for emotions they may experience in response to challenges abroad.

      Methods

      Pediatric GH educators from 7 institutions developed case vignettes incorporating common challenges residents experience abroad. Residents participating in a GH training track or planning to participate in a GH rotation from the 7 institutions were eligible to participate in the simulation curriculum. Participants and trained facilitators completed postsimulation evaluations that were analyzed using descriptive statistics and thematic analysis of written comments to assess the utility of the curriculum, emotions evoked, and changes residents anticipated making to their GH rotation preparation.

      Results

      Fifty-one residents and 16 facilitators completed 160 and 52 evaluations, respectively. Overall, respondents found the simulations useful (mean [SD] resident score 4.49 [0.82] and facilitator score 4.85 [0.36] on a 5-point scale [1 = completely useless, 5 = very useful]). Residents reported strong emotions in 153 (98%) of 156 comments. After the sessions, 131 (96%) of 137 comments reflected anticipated changes to GH rotation preparation plans.

      Conclusions

      Active preparation for GH rotations using simulated cases appears to be a useful tool that can be implemented across a variety of sites with minimal facilitator training or simulation experience. The curriculum successfully elicited powerful emotions in residents and provided an opportunity to debrief these experiences before encountering them abroad.

      Keywords

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      References

        • Drain P.K.
        • Holmes K.K.
        • Skeff K.M.
        • et al.
        Global health training and international clinical rotations during residency: current status, needs, and opportunities.
        Acad Med. 2009; 84: 320-325
        • Barton A.
        • Williams D.
        • Beveridge M.
        A survey of Canadian general surgery residents’ interest in international surgery.
        Can J Surg. 2008; 51: 125-129
        • Jayaraman S.P.
        • Ayzengart A.L.
        • Goetz L.H.
        • et al.
        Global health in general surgery residency: a national survey.
        J Am Coll Surg. 2009; 208: 426-433
        • King R.A.
        • Liu K.Y.
        • Talley B.E.
        • Ginde A.A.
        Availability and potential impact of international rotations in emergency medicine residency programs.
        J Emerg Med. 2013; 44: 499-504
        • Lungren M.P.
        • Horvath J.J.
        • Welling R.D.
        • et al.
        Global health training in radiology residency programs.
        Acad Radiol. 2011; 18: 782-791
        • Matar W.Y.
        • Trottier D.C.
        • Balaa F.
        • et al.
        Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties.
        Can J Surg. 2012; 55: S191-S199
        • Powell A.C.
        • Casey K.
        • Liewehr D.J.
        • et al.
        Results of a national survey of surgical resident interest in international experience, electives, and volunteerism.
        J Am Coll Surg. 2009; 208: 304-312
        • Nelson B.D.
        • Lee A.C.
        • Newby P.K.
        • et al.
        Global health training in pediatric residency programs.
        Pediatrics. 2008; 122: 28-33
        • Elit L.
        • Hunt M.
        • Redwood-Campbell L.
        • et al.
        Ethical issues encountered by medical students during international health electives.
        Med Educ. 2011; 45: 704-711
        • Petrosoniak A.
        • McCarthy A.
        • Varpio L.
        International health electives: thematic results of student and professional interviews.
        Med Educ. 2010; 44: 683-689
        • Graber M.A.
        • Paniko C.
        • Buresh C.
        International medical student rotations: ethical and emotional dilemmas.
        J Global Health Perspect. 2013; (Available at:) (Accessed August 7, 2013)
        • Northrup R.S.
        Preparing students for overseas electives.
        Acad Med. 1991; 66: 92
        • Torjesen K.
        • Mandalakas A.
        • Kahn R.
        • Duncan B.
        International child health electives for pediatric residents.
        Arch Pediatr Adolesc Med. 1999; 153: 1297-1302
        • Shah S.
        • Wu T.
        The medical student global health experience: professionalism and ethical implications.
        J Med Ethics. 2008; 34: 375-378
        • Suchdev P.S.
        • Shah A.
        • Derby K.S.
        • et al.
        A proposed model curriculum in global child health for pediatric residents.
        Acad Pediatr. 2012; 12: 229-237
        • Federico S.G.
        • Zachar P.A.
        • Oravec C.M.
        • et al.
        A successful international child health elective: the University of Colorado Department of Pediatrics’ experience.
        Arch Pediatr Adolesc Med. 2006; 160: 191-196
        • Stanton B.
        • Huang C.C.
        • Armstrong R.W.
        • et al.
        Global health training for pediatric residents.
        Pediatr Ann. 2008; 37 (792–786): 786-787
        • Eneriz-Wiemer M.
        • Nelson B.D.
        • Bruce J.
        • Chamberlain L.J.
        Global health training in pediatric residency: a qualitative analysis of faculty director insights.
        Acad Pediatr. 2012; 12: 238-244
        • Gladding S.
        • Zink T.
        • Howard C.
        • et al.
        International electives at the university of Minnesota global pediatric residency program: opportunities for education in all Accreditation Council for Graduate Medical Education competencies.
        Acad Pediatr. 2012; 12: 245-250
        • Sawatsky A.P.
        • Rosenman D.J.
        • Merry S.P.
        • McDonald F.S.
        Eight years of the Mayo International Health Program: what an international elective adds to resident education.
        Mayo Clin Proc. 2010; 85: 734-741
        • Bozinoff N.
        • Dorman K.P.
        • Kerr D.
        • et al.
        Toward reciprocity: host supervisor perspectives on international medical electives.
        Med Educ. 2014; 48: 397-404
        • Jones R.
        • Finlay F.
        Medical students’ experiences and perception of support following the death of a patient in the UK, and while overseas during their elective period.
        Postgrad Med J. 2014; 90: 69-74
        • Beaubien J.M.
        • Baker D.P.
        The use of simulation for training teamwork skills in health care: how low can you go?.
        Qual Saf Health Care. 2004; 13: i51-i56
        • Eppich W.J.
        • Adler M.D.
        • McGaghie W.C.
        Emergency and critical care pediatrics: use of medical simulation for training in acute pediatric emergencies.
        Curr Opin Pediatr. 2006; 18: 266-271
        • Eppich W.
        • Howard V.
        • Vozenilek J.
        • Curran I.
        Simulation-based team training in healthcare.
        Simul Healthc. 2011; 6: S14-S19
        • Eppich W.J.
        • Nypaver M.M.
        • Mahajan P.
        • et al.
        The role of high-fidelity simulation in training pediatric emergency medicine fellows in the United States and Canada.
        Pediatr Emerg Care. 2013; 29: 1-7
        • McGaghie W.C.
        • Issenberg S.B.
        • Petrusa E.R.
        • Scalese R.J.
        A critical review of simulation-based medical education research: 2003–2009.
        Med Educ. 2010; 44: 50-63
        • Demaria Jr., S.
        • Bryson E.O.
        • Mooney T.J.
        • et al.
        Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance.
        Med Educ. 2010; 44: 1006-1015
        • Fraser K.
        • Huffman J.
        • Ma I.
        • et al.
        The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial.
        Chest. 2014; 145: 958-963
        • Cheng A.
        • Hunt E.A.
        • Donoghue A.
        • et al.
        Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.
        JAMA Pediatr. 2013; 167: 528-536
        • Denzin N.K.
        • Lincoln Y.S.
        Collecting and Interpreting Qualitative Materials.
        Sage Publications, Thousand Oaks, Calif1998
        • Arora S.
        • Ahmed M.
        • Paige J.
        • et al.
        Objective structured assessment of debriefing: bringing science to the art of debriefing in surgery.
        Ann Surg. 2012; 256: 982-988