Cross-border simulation training: Implementation strategies to bridge the global medical education gap

Geopolitical barriers and the impact of COVID-19 impede Palestinian medical students from accessing clinical opportunities. We set out to bridge this gap and improve performance in medical emergency scenarios by comparing three methods of implementing a cross-border medical simulation programme. Using UK based medical simulation software, lecturers and facilitators; we compared the viability and impact of unsupervised and guided usage of medical simulation software amongst medical students in Palestine. Summary Of Work Prospective multi-site non-randomised study of Palestinian medical students (n = 45) training in medical emergency management (September 2020 - February 2023). All students were given access to medical simulation software (Oxford Medical Simulation TM (OMS)). They were allocated into three programmes: Programme 1 (P1): independent simulation training only; Programme 2 (P2): simulation training alongside a medical emergency lecture series (no medical simulation content); Programme 3 (P3): example based simulation lecture series followed by independent simulation training. Primary outcome: post-programme attainment score across seven simulated medical emergency scenarios. Secondary outcome: student subdomain performance (communication, technical, non-technical and teamwork skills). Scoring was completed using validated computer-grading via OMS. Qualitative feedback collected through feedback forms. All data analysed using one-way ANOVA (Microsoft Excel). Results Across seven scenarios, average attainment was 45.0%, 35.1% and 47.9% in P1 (n = 16), P2 (n = 15) and P3 (n = 14), respectively. There was no statistically significant difference in student attainment (F = 1.19, p = 0.33). The difference in performance was not statistically significant across any of the subdomains (p >0.05). However, the scores are consistently higher in P3, the medical simulation specific tutorials, which could suggest an area for future development. Anonymised feedback (n = 26) showed 3.76/5 average agreement with that ‘use of international software was relevant to practice in Palestine’. The general approach to emergency scenarios remains the same however the difference in resources and access to certain scans and medications could explain the discrepancy. About 32% of students also faced technical challenges with the software which (according to target study groups) included difficulties with consistent internet connection and incompatible technology. Conclusion The use of an additional framework of lectures and guidance did not improve attainment compared to independent usage of medical simulation software amongst Palestinian medical students. This study suggests donation of medical simulation software for independent student-guided usage is a low cost, locally relevant and technically feasible way to supplement medical education, without requiring additional cost-prohibitive guidance and supervision. This is a potential focus for future global medical education initiatives. Take Home Messages Medical simulation could supplement international medical education to bridge global clinical opportunities gaps without the need for cost-prohibitive guidance or supervision.