Co-creating a simulation curriculum for refugee doctors with diverse learner needs

IntroductionDoctors with refugee status are a heterogeneous group of learners with unknown educational needs for entering new workplaces. Better processes for integration into the healthcare workforce may improve refugee doctors’ experiences and contribute to addressing the current healthcare workforce crisis. Simulation-based education has the potential to assist with refugee doctors’ integration, but this has not yet been studied. We describe a novel approach to co-creative action research for simulation-based curriculum development. This example may inform others who are developing curricula for learners with unknown needs.MethodsThe simulation curriculum was developed through collaboration with the Scottish Centre for Simulation and Clinical Human Factors, The Bridges Doctor Program both based in Scotland and Vital Anaesthesia Simulation Training. Over 1 year, teaching action research cycles (plan, act, observe and reflect) were employed at both macro (whole curriculum) and micro (single scenario) levels to develop a new simulation curriculum with refugee doctors. Written and verbal feedback from faculty and learners, in addition to field note diary entries, were collected throughout the process.ResultsEighteen refugee doctors participated. The resultant curriculum comprised 6 days of simulation-based learning, including an introduction to simulation, the systematic approach, multidisciplinary teamwork, collaborative decision-making and 2 days of acute medical emergency scenarios. Action research cycles influenced curriculum development at the macro level, for example, faculty learned how to use social media and concise pre-learning to maximize learner engagement. At the micro level, action research helped faculty to provide appropriate clinical knowledge sessions and change their approach to teaching behavioural skills.DiscussionSimulation curriculum development for learners with unknown needs is challenging. Taking a co-creative approach throughout development increased the likelihood that the curriculum priorities were truly agreed between learners and faculty. Social connections between learners and faculty played a significant role in the success of the simulation curriculum. The co-creative action research approach could be replicated by others involved in simulation development, particularly when learners’ needs are unknown or heterogeneous

Reclaiming identities:exploring the influence of simulation on refugee doctors’ workforce integration

Background: Healthcare professionals are a precious resource, however, if they fail to integrate into the workforce, they are likely to relocate. Refugee doctors face workforce integration challenges including differences in language and culture, educational background, reduced confidence, and sense of identity. It has been proposed that simulation programmes may have the power to influence workforce integration. This study aimed to explore how an immersive simulation programme influenced workforce integration for refugee doctors joining a new healthcare system. Methods: Doctors were referred to a six-day immersive simulation programme by a refugee doctor charity. Following the simulation programme, they were invited to participate in the study. Semi-structured interviews, based on the ‘pillars’ conceptual model of workforce integration, were undertaken. Data were analysed using template analysis, with the workforce integration conceptual model forming the initial coding template. Themes and sub-themes were modified according to the data, and new codes were constructed. Data were presented as an elaborated pillars model, exploring the relationship between simulation and workforce integration. Results: Fourteen doctors participated. The ‘learning pillar’ comprised communication, culture, clinical skills and knowledge, healthcare systems and assessment, with a new sub-theme of role expectations. The ‘connecting pillar’ comprised bonds and bridges, which were strengthened by the simulation programme. The ‘being pillar’ encompassed the reclaiming of the doctor’s identity and the formation of a new social identity as an international medical graduate. Simulation opportunities sometimes provided ‘building blocks’ for the pillars, but at other times opportunities were missed. There was also an example of the simulation programme threatening one of the integration pillars. Conclusions: Opportunities provided within simulation programmes may help refugee doctors form social connections and aid learning in a variety of domains. Learning, social connections, and skills application in simulation may help doctors to reclaim their professional identities, and forge new identities as international medical graduates. Fundamentally, simulation experiences allow newcomers to understand what is expected of them. These processes are key to successful workforce integration. The simulation community should be curious about the potential of simulation experiences to influence integration, whilst also considering the possibility of unintentional ‘othering’ between faculty and participants.</p

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon.

Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation-a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation

Acute pain management in methadone maintenance treatment / by Mark Doverty.

"December 2001"Includes bibliography.1 v. (various paging) : ill. ; 30 cmIn the light of a general concensus that in the treatment of pain, patients with a prior history of substance abuse (particulary opioid dependence) appear to be at increased risk for pain mismanagement problems, this thesis aims to produce data that will eventually help in the formulation of prescribing guidelines, improved policies, and help direct optimal acute pain management for methadone maintenance patients.Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical and Experimental Pharmacology, 200