Building SELF Training Modules: Developers in Action

Report from Workshops in Nairobi & Abuja

ECSACONM nurses take a break from filming instructional training videos at The Nairobi Hospital in Kenya.

In September, members of the West African College of Surgeons (WACS) and the East, Central, and Southern Africa College of Nursing and Midwifery (ECSACONM) convened in Abuja, Nigeria and Nairobi, Kenya respectively to attend workshops aimed at advancing training modules in high-priority surgical areas. While the ECSACONM workshop concentrated on perioperative skills, the WACS workshop focused on the construction of simulators and the development of psychomotor skills assessments. Energized by participants’ shared commitment to the SELF mission, both workshops built on the momentum of previous meetings — underscoring the vital role these collaborative efforts play in pushing our work forward.

Since SELF launched in 2023, developer workshops have been instrumental to our progress. Catherine Mohr, President of the Intuitive Foundation, credits this to the time and space the workshops provide: “There’s enough time to rewire; people aren’t getting pulled in lots of different directions, so we can really focus on the task at hand.”

For participants, the workshops brought to life the SELF Developer Playbook, enabling them to more easily conceptualize, deconstruct and refine training modules — especially ones involving complex simulators. According to Professor Ben Jiburum — Professor of Surgery and Consultant Plastic Surgeon at the Imo State University Teaching Hospital — “we were able to visualize the materials that could be used to build the simulators.” Professor Jiburum, who played an important role in the WACS workshop in Abuja, became involved with SELF after being inspired by the positive outcomes of earlier workshops: “When I saw the laparoscopic box and an external fixator my colleagues had created, I was impressed.” Now he and his team are developing a skin grafting module, for which they had to ask themselves:

“How can we simulate the layers of the skin in a way that allows for the removal of some parts, and how can we ensure it is stretchy rather than inelastic? Together we were able to visualize this and come up with potential solutions...”

WACS surgeons pose with their SELF scrub caps after two days of planning several training modules.

The collaborative, interdisciplinary nature of the workshops is key to their effectiveness. A WACS team led by Dr. Emmanuel Ameh — Professor of Paediatric Surgery, National Hospital, Abuja, Nigeria — tried and tested 14 different prototypes of the simulator for their module teaching safe pediatric male circumcision. It was critical to ensure that the materials the simulator is made from — plasticine and clay — behaved just like a real foreskin.

The SELF framework is rapidly gaining traction thanks to its demonstrated potential to address shortfalls in the traditional training paradigm. Reflecting on the recent workshops, Dr. Ameh expressed the following thoughts:

“I’ve come to realize that the training modules are an effective way of accelerating skills acquisition for trainees and surgical, anesthesia and perioperative nursing providers at district-level hospitals — without the challenges of using actual patients. But we do need to be careful, selective and realistic in identifying which procedures should be simulated, and we must continuously evaluate, modify and improve.”

Dr. Ameh’s work addresses surgeon shortages and training deficits in district hospitals:

“Access to specialist pediatric surgeons in my area is limited — there aren’t enough surgeons, and those we have are nearly all located in tertiary hospitals in cities. Consequently, children with conditions that require surgery are not receiving the care they need, or the care they are receiving is being provided unsafely by non-specialist physicians — thereby increasing the risks and leading to avoidable complications.”

In response to these issues, Dr. Ameh and his colleagues are developing several training modules, one of which teaches practitioners how to treat umbilical hernias — a common condition in his field. Another teaches intraosseous infusion (IO):

“Vascular access for children in emergency situations can be difficult. In such situations, intraosseous access becomes a life-saving procedure. Every provider working in these emergency situations should be proficient in IO access.”

Strength in Numbers

The workshops provided participants with a valuable in-person opportunity to meet and learn from peers in the community, all of whom are committed to advancing SELF’s mission. Attendees relished the camaraderie and team spirit.

Julie Commettant, a proud Seychellois nurse who participated in ECSACONM workshops in Zimbabwe, Malawi and Nairobi — where she worked on and helped film a patient transfer module — came away from the experience feeling grateful and empowered. Although Julie has worked in the operating theatre for almost two decades, her training, she says, has been exclusively “on the job.” For her, the workshops were an unprecedented chance to gain insight into the ways her counterparts in other countries approach nursing: “Learning how other practitioners do things has given me the opportunity to make a difference in my country.”

Looking Ahead
 SELF continues to go from strength to strength owing to the extraordinary efforts and enthusiasm of the community. This is reflected in the decision of the Nigerian Ministry of Health to incorporate cost-effective simulation in its revised surgical plan for the training of frontline surgical, anesthesia and perioperative nursing providers.
 While many challenges lie ahead, our pace of progress is fast and we are learning at every step — as Catherine Mohr puts it, “we’re building an airplane while we’re flying it.”

This one speaks for itself.