Page 44 - JSOM Spring 2021

Results are provided as a median (95% confidence interval). FIGURE 1 Simulation.
Comparisons were done using the paired samples Wilcoxon
test. All statistics were done using MedCalc v17.7 software
(MedCalc Software). Statistical significance was assumed at
p < .05.
The Sainte Anne Military Teaching Hospital Ethics Commit-
tee reviewed this study and gave its approval. Because of the
study’s retrospective nature, participants’ consent was not
deemed necessary.

Results
Course Description
Six SC3 training sessions have so far been held in Libreville.
A total of 62 trainees from five countries have participated in
the course. Physicians accounted for 42% of the trainees and
nurses for the remainder (Table 2).

TABLE 2 Training Session Participants FIGURE 2 Simulation.
Nurses (n = 36) Physicians (n = 26) Total (N = 62)
Precourse 4 (2–5.5) 19 (13.75–24.25) 4 (2–8)
Postcourse 7 (4.25–11.5) 25 (22.75–29.5) 9.5 (5–18)
p Value .01 .4 .04
Results are provided as a median (95% confidence interval).

Trainees were military nurses and physicians from partner
nations of Central and West Africa. Ten students attended
each course and were divided into five two-person teams. A
standardized medical kit was provided at the beginning of the
course and replenished after each simulation. Four instructors
from the CESIMMO, including one physician, two nurses,
and a simulation technician, were in charge of the course. Staff
from the 6BIMA and the EASSML assisted them.

The course is divided into two 1-week phases. The first week
uses various pedagogic modes, including lectures on CCC,
practical workshops, and high-fidelity simulation. The em-
phasis is on the mastery of the theoretical content, of tech- Evaluation of Knowledge Improvement
nical procedures, and of the management of a single combat Data from the first training week’s pretests and posttests were
casualty. Workshops are conducted using task trainers for available for all trainees. Trainees’ knowledge improved during
decontextualized practice of procedures, such as hemorrhage the course, from a median of 4 to 9.5 (p < .05). Subgroup
control, intraosseous vascular access, or cricothyroidotomy. analysis revealed that pre- and post-course scores were higher
for nurses but not for the physicians. Self-reported satisfaction
Simulations are held daily using either a high-fidelity manikin was rated as high. All participants but one, who sustained an
(Laerdal ALS; Laderal Medical) or a moulaged standardized injury, completed the 2 weeks of the course.
patient. Those simulations are undertaken in pairs, usually a
physician and a nurse, and involve only one patient. The main Discussion
objective is the medical management of a severely wounded
patient. This experience shows that implementing a high-fidelity sim-
ulation program for a CCC training setting is feasible. To our
The second week of the course is entirely held in the equatorial knowledge, cross-cultural CCC training has been described
forest. Trainees are instructed in the basics of the jungle envi- only for basic first aid skill. Our study differs in its descrip-
2,3
ronment, where they live for the week. High-fidelity, interpro- tion of a CCC program for foreign medical providers.
fessional simulation scenarios are carried out, with an emphasis
on multiple victims’ situations. Victims are either manikins or, Our results indicate that our trainees’ initial levels were prob-
for the less severe cases, simulated patients (Figures 1 and 2). ably very heterogeneous, as the discrepancy between nurses’
Each scenario includes care under fire, then an evacuation and physicians’ scores suggest. However, only the nurses’
phase, and additional care in a simulated Role 1. Participants scores significantly improved during the course. This might
must interact both among themselves and with other soldiers. indicate the need to tailor the course contents to the true level
Scenarios include vehicle and foot patrol incidents, as well as a of the students. In this particular case, the first week of the
night attack on the trainees’ camp. A mass casualty incident is following sessions will be different between physicians and
simulated on the last day, with 20 simulated victims. nurses to account for this performance gap.

42 | JSOM Volume 21, Edition 1 / Spring 2021