Conceptual framework for a cardiac surgery simulation laboratory and competency-based curriculum in Pakistan - a short innovation report

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: a simple bench model, a virtual reality simulator and a unique human performance simulator. Our multitiered approach allows for appropriate sequential trainee skill progression. Finally, we hope that our model inspires the development of similar curricula and modules for trainees belonging to other surgica

Social Incubation in Pakistan: Enabling Student Mobilization During the COVID-19 Pandemic

To the Editor: Developing countries, like Pakistan, with limited resources and budding health systems, face intense fear and despondency amongst the public, leading to worsening outcomes as wave after wave of the pandemic hits. (1) This helplessness is felt most by students and various health profession trainees who are the least vulnerable, yet the most underutilized. Combatting this frustration led to five medical students strategizing a mechanism to amass the country's collective resilience, expertise, and knowledge. This endeavor has since grown from March 2020 into an international autonomous taskforce of 700+ volunteers: The Student Taskforce Against COVID-19, an assortment of ten distinct COVID related efforts. (2,3) As we transitioned from a social incubator to a need-of-the-hour platform, our experiences taught us that five key values were central to enabling trainee led reform: a) strong leadership amongst working groups, b) strategic innovation targeted at developing real-time solutions to emerging and existing healthcare problems, c) reliable communication of authentic and relevant information in the midst of rumor and misinformation overload, d) community support and partnerships on individual and regional levels, and e) multidisciplinary teamwork amongst diverse volunteer groups. (Read more about us at: http://www.stac19.org/). Our initiatives relied on synergism between backgrounds in allied health, engineering, media, marketing, and entrepreneurship. The diversely skilled volunteers from across Pakistan led efforts ranging from telehealth programmes focusing on national critical care support and virtual mental health counselling, to training and informational programs for staff and residents at senior citizen homes and for the general public via a centralized student-manned helpline. The approach to these programmes was founded on the balance between functionality and sustainability with stakeholder involvement integrated at every tier. Although our experiences in Pakistan did face educational and economic limitations, they were very similar to patterns of student involvement in combating this crisis globally. (4) What this initiative has shown is that the interplay between diversity, synergism and collaboration is the key foundation for large-scale impact. This model of student mobilization can be reproduced in other crisis settings beyond the pandemic, beyond healthcare settings and beyond socioeconomic barriers. Continuous..

Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system

Abstract Background In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities. Methods To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles. Results A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. Conclusion Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities