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Harnessing MSF Field Simulation for Operations

This project aims to bridge the gap in medical care quality caused by insufficient hands-on training in medical/nursing schools by providing experiential and practical education through field-based simulation learning solutions.

Tell us about the problem you are trying to solve.

With a mission to provide lifesaving medical care to those most in need, MSF consistently works to strengthen the standard of care for our patients. However, delivering quality care remains a challenge for MSF in many low-resource settings, especially where health systems are fragile and access is limited. There is a gap in hands-on training available in medical and nursing schools; lack of experience in our junior medical and nursing staff; and a lack of resources/training skills at MSF to conduct practical learning.


What is your solution? What motivates you to work on addressing this problem?

Experts say that 70% of learning comes from experience (on-the job-training) and that “practice by doing” is one of the most effective learning methodologies. In fact, the experiential retention rate is 90%. Simulation-based solutions emulate on-the-job realities and offer a safe training environment in which our staff can also face situations not yet experienced.

Simulation-based learning has become an integral part of the medical and nursing education outside MSF. It is a methodology that can develop our staff’s knowledge, skills, and attitudes in our projects while protecting patients from unnecessary risks.

By bringing simulation-based learning into MSF operations, our frontline staff gain access to practical onsite learning experiences and the opportunity to build competencies and confidence to perform their roles as health care providers. It “builds a parallel, controlled and secure reality” that enables us to learn, innovate, reflect, provoke changes and define new ways of working for people, teams and the organization itself.


What have you done so far and what results have you achieved?

The project team completed an 18-month TIC incubator project, which deployed and tested “field medical simulation-based learning solutions” for use at the project-level. The team designed and piloted integrated solutions into field operations in Gowza, Nigeria; Batangafo, Central African Republic; and Kumba, Cameroon.

The MSF Field simulation team designed 126 medical scenarios, building specific and effective simulation-based learning programs. Pilot sites implemented medical-operational simulations in pediatrics and neonatology; a decentralized model of care; trauma care; mass casualties; cholera; diphtheria, and others.

By the end of this first Phase, 14 simulation local facilitators were trained. These trained facilitators implemented 433 simulation sessions with participants in their respective projects with support from the Simulation team. In total, 286 staff have participated in simulation activities in the pilot project locations, with each participant attending between 1 and 16 simulations.

This video shows an example of a simulation run by the MSF Cameroon mission to prepare teams to respond to a mass casualty incident (Cameroon, Emergency Preparedness), and includes testimonies that explain the benefits of using simulation as an operational model, and its contribution to improving the quality of care in MSF projects.


How has your project pivoted to support MSF’s response to the COVID-19 pandemic?

The MSF Field Simulation team has produced a series of videos to support field teams in preparing for COVID-19. The video package is helping teams organize simulation-based learning on Infection Prevention and Control measures. The target audience is frontline staff working with suspected/confirmed COVID-19 cases including health care workers, cleaners and drivers.

The package, which is available in English, French, Spanish, Portuguese and Arabic, has been uploaded to the TEMBO platform and has already been viewed by more than 700 staff. In addition, field teams are using these videos to organize several simulation-based training sessions to train both MSF and Ministry of Health staff. Participants, supervisors, and staff at headquarter level are seeing the benefits of the videos as a preparation to better understand the procedures and protocols to apply when responding to COVID-19. The Field Simulation team is developing additional videos based on field demand.


What lessons have you learned? What is next?

Simulation has shown effective results in learning and its transfer to the workplace. Overall, participants want to use simulation methodology more frequently. More than 85% ranked the simulations as highly favorable, engaging and relevant. Participants cited that the simulation created a safe and engaging learning environment; helped them to reflect and to understand things they already knew and/or used to do, and how to do them properly; and brought together theory, clinical demonstrations and practice without harming real patients.

Participants felt that simulations increased their confidence and commitment to apply what they had learned. 90% of participants strongly agreed that using simulation helps to understand the importance, benefits and the consequences of doing or not doing specific actions. They believed that it is worthwhile to apply the learnings, and expressed they were willing to do things differently to improve the quality of care provided.

A Phase 2 TIC incubator project was recently approved, to pilot the scale-up and integration of simulation into MSF in a sustainable manner to positively impact MSF’s medical and humanitarian interventions. The project team believes that simulation can be used to monitor and improve quality of care, to strengthen emergency preparedness, and to promote innovation and new ways of working.


Are there any interesting partners that you are collaborating with?

We are collaborating with the TEMBO project to create a blended learning program and exploring the possibility of digital simulation.

We’re also working with the MSF Academy project to build their team’s capacity to deliver simulation methodology. They are already using simulation to design learning programs adapted to the learner’s level, especially in situations where there is wide range of skill levels amongst staff.

Finally, we are planning to engage with OCP’s Dubai simulation initiative to exchange knowledge, experiences and lessons learned related to simulation methodology.


What is the expected long-term impact of the project? How will this project improve MSF’s lifesaving work?

We believe that this project is meeting field demand for simulation training and will successfully address known gaps in quality of care. We also believe it improves staff confidence and capability to perform specific clinical/nursing practices and technical practices safely and effectively.

In January 2020, the Medical Coordinator of MSF OCBA’s Nigeria mission reported how the project team had effectively reacted to a mass casualty event after having been trained through simulation training.

Ultimately this will contribute to MSF’s ability to deliver increased quality of care and effectively respond to current and emerging medical and humanitarian crises. It will also foster transformation in the organization as it supports the needed change of mind-sets and attitudes to provoke desired ways of working.