PC2117: Sustaining Capacity Building and Procedural Skill Training During the COVID-19 Pandemic: Lessons from India

Background: The Ronald Reagan Institute of International Emergency Medicine at George Washington University has in-country partnerships across India that implement a 3-year post-graduate Emergency Medicine (EM) training program. Due to the pandemic, academic support transitioned to a virtual format. While some training needs could be met through structured online video conferencing, procedural skill training, an essential component of EM training, posed a challenge. In January 2022, we taught suture skills through a virtual workshop followed by an optional Suture Challenge for trainees to demonstrate skills learned. Prior to the suture workshop, trainees attended didactic sessions throughout the month including pediatric wound management and pediatric pain management techniques.

Methods: To teach suture skills a two-hour virtual procedure lab was held via an online platform. Program directors and trainees were notified in advance and provided with a list of materials needed to participate. Trainees were also given a list of alternatives to the traditional suture pad, including dense foam covered in fabric, raw meats, and a variety of fruits. The suture pad alternatives could be used to simulate pediatric and adult wounds and allowed residents to participate regardless of site equipment or trainee location. During the procedure lab two wound management specialists demonstrated advanced suture techniques, provided feedback on the trainees’ work, and answered questions. Trainee feedback was solicited anonymously after the session. Trainees were then invited to participate in the inaugural Suture Challenge. The challenge consisted of 2 parts: 1) demonstrate how to prepare for a laceration repair and 2) demonstrate a laceration repair, real or simulated, with encouragement to be creative.

Results: 160 trainees attended the virtual suture skills lab; 74 trainees submitted feedback which demonstrated that 94% of respondents were able to practice skills in real-time. Written feedback was overwhelmingly positive and included requests to implement this method for other procedural skills. 21 residents participated in the Suture Challenge. Two GW faculty evaluated the submissions using a rubric that evaluated adherence to instructions, complexity of laceration repair, and creativity of laceration repair. There was agreement between evaluators on the highest scoring submissions; winners were announced at the following grand rounds session.

Conclusion: Procedural skills are a key component of EM training. The combination of virtual teaching with the opportunity for real-time feedback and an integrated project to independently showcase skills is a way to continue procedural skills teaching in a remote environment. We believe the scale and detail of this virtual real-time, hands-on skill-based workshop is the largest of its kind. Additionally, we believe this provides a proof-of-concept model to further explore sustainable, cost effective and scalable models for remote procedure teaching.