Overview Of The Area Of Disaster Relief Medicine Training
Background of the study
The last 2 decades, the Malaysian government and Malaysian clinician has showed growing interest in disaster management & disaster relief medicine. After the event that shook the hearts of Malaysian, the collapse of Highland Tower in 1993, the government of Malaysia realised the importance of having a policy in times of disaster. National Security Council (NSC) Directive 20 was published in 1997 for this purpose. It has become Malaysia’s main guideline for disaster response management in Malaysia. The management mechanisms prescribed by the directive are according to the level and complexity of disaster and determines the responsibilities and roles of various agencies ensuring effective mobilization and coordination of resources when handling disasters. The frequency and intensity of disasters, both man-made and natural, have noticeably increased over the past few decades. Their effects caused great suffering, huge mortality, massive economic losses, serious environmental degradation and lasting psychological impairment of the survivors. Majority of medical curricula do not incorporate the principles of Disaster Medicine. Sinha A and colleagues described there was insufficient knowledge, attitude & practice among medical undergraduates in India about disaster and disaster preparedness. Disaster medicine which is crucial in such events, has been traditionally a postgraduate training module. However, in the face of large scale disaster, or major incidents in a small district hospital, where personnel trained in disaster medicine (i.e. Emergency Physicians) are not enough, young junior medical officers, or medical students might need to assist.In view of gaps of in undergraduate & postgraduate disaster medicine education, several medical universities for undergraduates has developed curricular in disaster medicine for undergraduates.
A 2008 survey of Emergency, Family, and Pediatric Residency programs supports the notion that physician trainees are not being properly trained in disaster medicine. Of the respondents in this survey, only 20% of Pediatric and Family Medicine Resident training programs in the United States (US) reported adequate training for responding to terrorist events, whereas, 50% of Emergency Medicine Residency training programs reported adequate training for events affecting children. A 2009 survey of 523 medical students showed that just 17.2% of respondents felt they were receiving sufficient training for a natural disaster, whereas 96% of students expressed interest in assisting in such an event.
In a study conducted in 2014, more than one-half of residents in Emergency Medicine reported that they believed they did not receive enough training in disaster medicine during their residency to feel competent. Other studies have demonstrated poor understanding of disaster medicine concepts among practicing Emergency Physician who have completed residency. Therefore, there is a clear need to improve and expand educational opportunities in disaster medicine not just for medical students, but also for Emergency Physicians to enhance the readiness of the nation’s emergency care systems. However, there are several challenges identified that limits the improvement in disaster medicine education in the current environment. First, there are already substantial practical limitation on expanding classroom instructional time for disaster medicine in undergraduate medical programs, with so many programs struggling to incorporate all the required content of medical studies in the five- or six-year curriculum. Second, for medical students, it can be hard to gather them in a single educational setting, given academic schedules and other commitments. Third, some undergraduate medical programs have lack direct access to experts in disaster medicine who are capable of providing in-person education on regular basis to large number of students. Faced with this challenges in educating the medical students in the ever-expanding body of knowledge of disaster medicine, e-learning has been suggested as a promising alternatives to the use of traditional lecture (TL) methods. The primary purpose of this study is to explore the area of learning DRM by using e-learning method as a complimentary or possibly substitute to the traditional didactic lectures. 7 topics on disaster relief medicine (DRM) has been chosen to be the content of the video. They are definition of DRM, classification of DRM, staging of DRM, aims of DRM, DRM activation process, and principles of field triaging.
Review of the literature
Disaster relief medicine training in undergraduate medical education
In times of catastrophe or disaster, the public are expecting medical personnel especially doctors to perform well when these incidents occurs. This is very challenging as it has been traditionally a postgraduate training. Traditional medical education and assessment criteria have been largely clinically oriented to the neglect of disaster medicine. Health care providers play important roles during major incident event, unfortunately, a lot of them were not prepared and the number trained to response is quite limited. A local study conducted in 2016 among emergency nurses (EN) and community health nurses (CHN) showed that there was inadequate knowledge among them in managing disaster. 72.7% and 80.0 % of CHN and EN respectively had never attended education about disaster management. In 2003, the Association of American Medical Colleges (AAMC) realized the importance of disaster management knowledge, issued a report that called for incorporating disaster training for weapons of mass destruction and other public health emergencies into the medical student curriculum for all years.
In 2010, a study conducted on medical students regarding the implementation of a novel disaster medicine training curricular shown that medical students value and can rapidly apply core concepts of disaster response. Hence, disaster medicine trainings are well received by the medical students and can be easily added to the medical curricular. Over the last decades, there are increasing encouraging published reports on early introduction of disaster relief medicine to be incorporated in the undergraduate medical curricular, and they are commonly taught in face-to-face lectures as the prevailing instructional methods. However, they do not appear to b3e the most appropriate choice to convey a practical skill. This has prompted research on new method to teach DRM to medical students.
Blended approach on disaster relief medicine
Many teaching philosophies have highlighted 3 main domains of learning objectives: cognitive, affective and psychomotor. To master or perform a procedure, psychomotor skills development works closely with cognitive thinking. Despite that, psychomotor learning is not well studied as majority of educational reform focused on high level cognitive skills learning. Perception, which requires sensory experiences, contact and touch to the materials, tactile skin pressure and audio-visual perception, has been described as one of the most fundamental stage in the hierarchy of psychomotor domain. We believed audio-visual perceptions in learning psychomotor skills are important and should be offered as an option of learning to the medical students to meet their individual needs and to increase diversity of learning styles.
Traditionally, clinical knowledge and practical skills was taught by conventional methods of didactic lectures and tutorial through face to face learning. However, there are several challenges to this method. The number of students has outgrown the instructor or teacher, hence in many institutions, there is disparity ratio of teacher to student and this has led to limited student contact-time. Due to this, skills are ineffectively learned. Other factors that were found to be unfavourable in respect to face to face method are: the need for a big classroom, variable of information delivery by instructors, the cost of qualified instructors, excessive didactic information, fixed time schedule, logistical consideration and inconvenient learning environment.
For reinforcement of clinical skills in emergency room, a blended learning model was introduced. Its strategies include combination of traditional classroom instruction with variety of instructional media technologies. Currently, e-learning and audio-visual program has rapidly growing as popular educational tools to promote engagement and improves performance in clinical skills.
A study by Saiboon IM, the author demonstrated comparable outcome between self-instructional video (SIV) and face to face (FTF) instruction in learning basic emergency skills. The study reported that confidence level in basic airway management, splinting and cervical collar application are better in SIV group than in the FTF group.
E-learning: Revolutionizing learning strategy in medical education
E-learning uses two or more media, such as text, graphics, animation, audio or video to produce engaging content that learners can access via computers or phone. Often cited advantages of e-learning includes increased accessibility to information, ease in updating content, personalized instructions, ease of distribution, standardization of content and accountability. Accessibility refers to the user ability to find what is needed, when it is needed. Learners have control over the content, learning sequence, pace of learning and time, which allow them to tailor their experience to meet personal learning objectives.
Plenty of evidences suggested that e-learning is more efficient because learners gain skills, attitudes and knowledge faster than through traditional instructor-led methods. This efficiency is likely to translate into improved performance and motivation. The effectiveness e-learning has been demonstrated primarily by studies of higher education, government, corporate and military environment. Most of these studies compare e-learning or video based learning with traditional instructor-led approaches. A lot of evidence in the nonmedical literature has shown, on the basis of sophisticated cost analysis, e-learning can result in significant cost-saving compared to traditional didactic lectures or instructor-led learning. Savings are related to reduced instructor training time, travel costs and labour costs, reduced institutional infrastructure, and the possibility of expanding programs with new educational technologies.
Chumley-Jones and colleagues reviewed 76 studies from medical, nursing and dental literature on the utility of Web-based learning. About one-third of the studies evaluated knowledge gains, most using multiple-choice written tests, although standardized patients were used in one study. In terms of learners’ achievements in knowledge, Web-based learning was equivalent to traditional methods.In both medical and nonmedical literature studies have demonstrated that students are satisfied with e-learning. Learners’ satisfaction rates increases with e-learning compared to traditional learning, along with perceived easy to use and access and user-friendly interface design. Interestingly, e-learning is not seen by the students as replacing traditional instructor-led training, but forming part of a blended-learning strategy, as a complement to it.
