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Evaluation of a simulation train the trainer course in Malawi


Presented at the 9th International Pediatric Simulation Symposium and Workshops 2017:  1-3 June, Boston, MA, USA

Background: Train the trainer (TTT) initiatives and low resource simulation have been used to support sustainable development in developing countries for the past 50 years. However, such programs have not been formally recognized for the value they bring to arenas such as continuing professional development of health workers (Dinero, 2005; Organization, 2012). Today, the interest in engaging low resource simulation based learning (SBL), inclusive of role play, in healthcare training and professional development is growing, and the benefits of such are only starting to be realized (Aggarwal et al., 2010; Organization, 2013). Given the significant investment of time and resources required to support SBL activities, there is urgent need to examine the advantages and challenges of integrating SBL in continuing professional education in developing countries.

Research Question: Can a two-day simulation TTT course focused on the Emergency Triage Assessment and Treatment (ETAT) curriculum lead to improved knowledge and participant perceptions of relevance related to the use of simulation in courses such as ETAT?

Method: A single group pre/post-test design was used to investigate the research question. The independent variable was the two-day TTT course using the ETAT content as a platform for learning. Key concepts in the course included adult and experiential learning, scenario design, teaching skills, pre-brief and effective feedback. The primary dependent variable was participant learning, measured by performance on the pre- and post-course knowledge tests. Secondary dependent variables were participants’ post-course evaluations, which examined their satisfaction with course organization, teaching methods, learning, attitudes and relevance using 4-point Likert scales.

Results: A paired-samples t-test was conducted to compare pre- and post-test scores. There was a significant improvement in participants’ scores from pre-test (M=6.08, SD=1.97) to post-test (M=8.08, SD=0.99); t(12)=3.12 , p =0.0007. These results suggest that the two day TTT course was effective in increasing participant knowledge related to integrating SBL in ETAT in Malawi. Results of participant evaluations indicate high levels of satisfaction across all aspects of the TTT course (M= 3.89, SD=0.25). Range of agreement varied from 3.67 (0.49) for suitability of venue to 4.00 (0.00) for teaching aids and effective teaching methods.

Discussion/Conclusion:  The curriculum grounding the TTT course was effective in enhancing health care worker knowledge of SBL within ETAT curricula in Malawi. Two days was sufficient for improving participant’s knowledge base, however many participants expressed interest in having more time for hands on application of concepts and would like to see the course delivered over a longer period of time. Future work will focus on assessing application of knowledge and delivery of SBL during future ETAT courses.


Aggarwal, R., Mytton, O., Derbrew, M., Hanane, D., Heydenburg, M., Issenberg, B., Reznick, R. (2010). Training and simulation for patient safety. Qual Saf Health Care, 19, i34-i43.

Dinero, D. P., OR: Productivity Press. . (2005). Training Within Industry: The Foundation of Lean. Organization, W. H. (2012). Designing and Implementing Training Programs.



Evaluation of a simulation train the trainer course in Malawi

Author Information

Elaine Sigalet Corresponding Author

Community Health Sciences, University of Calgary, Calgary, CAN

Ian Wishart

Emergency, University of Calgary

Faizal Haji

Peadiatrics, University of Western Ontario

Adam Dubrowski

Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN

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