The deficit is much greater in Papua New Guinea (PNG) where the doctor to population ratio is 0. In Myanmar, the doctor to patient ratio is 0.3:1000 whilst the nurse/midwife to patient ratio is 0.8:1000. Thailand has a ratio of 0.3 doctors per 1000 patients and although 65.7% of the Thai population live in rural areas, only 16.5% of doctors work in rural hospitals, compared with 28% of nurses and 20.4% of rural primary care workers. patients, significantly lower compared to 18. South East Asia has one of the highest deficits of healthcare professionals with a density of 4. Video-assisted feedback resulted in an improvement in clinical knowledge, confidence and quality of teamwork for managing medical emergencies in two low resource medical facilities in South East Asia and the South Pacific. The FGD revealed majority of participants felt that watching the video recording of their performance and the video-based feedback contributed most to their learning. Self-rated confidence scores by Thailand-Myanmar border participants increased significantly from baseline following training at week 1 ( p = 0.020), and while higher at 6 weeks follow up than at baseline, this was not significant ( p = 0.471). The global rating of the teams’ non-technical performance at both sites improved post feedback and at week 6 on the Thailand-Myanmar border site. PNG showed an improvement mainly in teamwork and task management. Thailand-Myanmar border TEAM scores demonstrated improvement post-feedback mainly in leadership, teamwork and task management which was sustained up to week 6. There was a trend for increased team OSCE scores compared to baseline at week 1 ( p = 0.068) and week 6 ( p = 0.109) although not significant. Individual paired tests of OSCE scores showed significant improvement post-feedback at week 1 ( p < 0.001) and week 6 ( p < 0.001) compared to baseline OSCE scores. Focus group discussions (FGD) were held at each Thailand-Myanmar border clinic at week 1 (8 participants at each clinic). Thailand-Myanmar border participants’ individual confidence levels and baseline knowledge (using OSCE scoring) were assessed before team assessment and feedback at week 1 and repeated post-feedback and at 6 weeks. The process was repeated post-feedback at both sites and at 6 weeks at the Thailand-Myanmar border site. The teams were recorded on video managing a simulated medical emergency scenario and the video was used to aid feedback and assess performance using Observed Structured Clinical Examination (OSCE) scoring and Team Emergency Assessment Measure (TEAM) questionnaire. Twenty-four study participants were recruited from three Shoklo Malaria Research Unit clinics along the Thailand-Myanmar border and eight participants from Kudjip Nazarene Hospital, PNG.
We explored the use of video-based feedback and low fidelity simulation for training rural healthcare workers along the Thailand-Myanmar border and Papua New Guinea (PNG) to manage medical emergencies effectively. Video-based feedback has been shown to aid knowledge retention, skills learning and improve team functionality.