Last Friday, President Uhuru Kenyatta opened the Aga Khan University Centre and granted Charter to the institution. President Kenyatta and Education CS Prof George Magoha also toured the university’s clinical simulation centre, which uses learning experiences that mimic real-life situations in clinical environments.
According to the World Health Organization, more 134 million adverse events occur in hospitals every year in the developing world. Such adverse events result in about 2.6 million deaths annually. As many as four in 10 patients experience adverse effects globally.
The prevalence of preventable adverse events – patient safety events that lead to severe temporary harm, permanent harm or death – demand a fundamental change in how we train nurses and doctors. Simulation-based teaching and learning allows acquisition of clinical skills through practice rather than the apprentice model of See One, Do One, Teach One.
Simulated clinical education and training demands that nurses and doctors are immersed in a representative patient-care scenario, a setting that mimics the actual clinical setting.
Simulation tools are an alternative to real patients. Clinical simulations for teaching and learning are created using mannequins, simulated patients or computer-generated simulations and part-task trainers.
Hence, trainees can make mistakes without fear of causing an adverse event.
Studying these mistakes, learning how to prevent and respond to them is critical to improving patient safety and reducing the prevalence of preventable adverse events. Simulation sessions are often followed by debriefing sessions to facilitate reflection, abstraction, conceptualisation and connection to real life encounters.
The country has one physician for 7,200 people, one clinical officer for 21,000 people and one nurse for 1,600 people. Who recommends one health professional for every 430 people. We fall far short. But the pressure to train health professionals must not lead us to compromise on quality of training. Our standards of training must be exacting, unyielding to easy path of massification of trainees and reckless proliferation of training institutions.
But the critical pillar in the quest for quality training is the standards for accrediting diploma, undergraduate nursing and undergraduate medical education programmes. Educators, regulators and professional organisations, together must re-evaluate the minimum standards for curriculum and training resources. Moreover, clinical skills training that is poorly integrated in the curriculum will not be better than the failed traditional approaches.
I am cognisant that a clinical simulation centre is not a trivial investment. But cost must not be an excuse for proliferating mediocre, dangerous health professionals. We must pool resources together and tap into local innovation to develop appropriate equipment for clinical simulation training. Well-trained actors can produce a clinical training experience at par with a high-fidelity mannequin.
Training institutions, the Commission for University Education, the Nursing Council of Kenya and the Kenya Medical Practitioners and Dentists’ Council must work together to set the highest standards for clinical education. Moreover, the public must continue to demand that public health facilities have the requisite quality of resources. One death or permanent harm from clinical or medical error is one too many.
Alex O. Awiti is Vice Provost at The Aga Khan University. The views expressed are the writer’s