Simulation Training in a Lower Middle-Income Country: Supporting a New Center and Developing Low-Cost Models for Critical Skill Acquisition

Introduction: There is a demand for surgical simulation training to be made accessible in low-resource countries. We conducted a pilot workshop at a new state-of-the-art simulation center and evaluated two novel low-cost surgical simulation models in a lower middle-income country (LMIC). Methods: A hands-on workshop to train local educators about simulation training was held at a new simulation center. Participant surveys were analyzed following the “training-the-trainer” workshop. Low-cost, hybrid-fidelity pericardiocentesis and thoracic cavity simulation training models were created using locally available materials. These models recreated the pertinent anatomy at a cost under 20 US dollars each. The models were used to train 109 postgraduate anesthesiology trainees during two hands-on medical education workshops. Participant surveys were collected and analyzed. Results: Of the local educators who participated in the “training-the-trainer” workshop, 65% “agreed” and 35% “strongly agreed” with the claim that the simulations better prepared the trainees to teach the clinical scenarios. Additionally, 65% of local educators “agreed” and 35% “strongly agreed" that the simulations prepared them to navigate interprofessional care in those scenarios. The low-cost pericardiocentesis simulation was ranked as “good” or “outstanding" by 100% of survey respondents. The low-cost thoracostomy simulation was ranked as “good” or “outstanding” by 64% of survey respondents. Both the pericardiocentesis and thoracostomy simulators were valued for their low-cost design, the recreation of essential anatomy, and immersive design elements. Conclusion: Our team successfully implemented novel simulators for skill training in an LMIC by working in close collaboration with local experts, with the advancement of local simulation instruction practices. Collaboration is key to increasing access to surgical simulations, particularly in low- to middle-income countries.