Sharing simulation-based training courses between institutions: opportunities and challenges
We report successfully sharing four SBT courses between two academic institutions. The time required to implement a shared course appears to be less than the time required to independently develop SBT courses, and this efficiency was perceived by instructors as the primary advantage to course sharing. However, a large initial investment of time was needed to develop the course-sharing infrastructure and many barriers were identified. While there are potential benefits with sharing SBT courses, our study demonstrates that sharing of content between institutions is not as simple as it may at first appear. Suggestions to improve the sharing process include use of a standardized template, clearly defining the target audience, providing a course overview, having someone experienced with the specific SBT course available to contact for questions, adopting a user-friendly sharing platform, and consideration of local needs.
If cross-site collaboration is anticipated, development of a shared template should be considered. A well-designed template could clarify the target audience, provide a course overview, and have contact information for questions that may arise when attempting to implement shared content. Many templates are currently in use, and attempts have been made to improve this tool for SBT [26]. However, an agreed upon standard template for use across all disciplines and institutions remains elusive.
An efficient, user-friendly, and secure tool for electronic document sharing is also essential. Institutional requirements for secure document-sharing platforms limited our options during this study with many users finding the cumbersome password and permissions process and limited accessibility to the content a significant barrier; we have yet to identify a platform that meets the requirements of both security administrators and end-users.
Our study was limited by the small sample size (only ten faculty members were involved) and involved two institutions with a similar culture and similar educational resources. Sharing will likely be more difficult if culture, language, or learning environment differ. In addition, the estimates for development and implementation time were self-reported and subject to recall bias. This bias was likely greater for the initial development estimate compared with the implementation estimate because development occurred farther in the past (months to years vs weeks). We did not obtain time estimates for implementation or development of the Moderate Sedation courses because each site already had developed its own version, nor did we obtain data from the students enrolled in these courses because this was not the focus of our collaboration (although the Central Line Workshop has been evaluated previously) [27, 28]. The estimate of total time and time savings are likely highly variable across institutions, and will probably vary even within institutions for different courses. It is possible that a much less formal collaboration could have resulted in successful sharing of curricula. The qualitative analysis was limited by the quantity and depth of raw data available, yet strengthened by the iterative review of all available data by several members of the research team, reporting of supportive quotes, and proposal of specific, pragmatic tips for success in future curricular sharing efforts.
Although previous studies have described collaboration to develop new curricula [16–21], we are not aware of a similar study describing direct sharing of existing SBT courses between institutions. Publishing course descriptions and materials in venues such as MedEdPORTAL and peer-reviewed journals is appropriate for some content but requires a formal submission process that many instructors will not pursue. Further, while not specifically studied, we anticipate similar barriers to implementation of shared content from these sources (e.g., unfamiliar template, difficulty understanding overall course flow). Our goal was to enlarge the inventory of available SBT courses ready for sharing at our institutions without adding additional burdens on authors. The scoring system we used to determine which courses were most ready for sharing has not been formally evaluated, and was performed by only one person at each institution. Further research is needed to determine how well this or other scoring systems identify courses that can be easily and successfully shared.
The current financial climate of health care provides a growing incentive to decrease costs and work differently to improve efficiency. Our data show that instructors view potential time savings as the single biggest advantage to implementing a SBT course developed at another institution. This successful sharing process might have shown greater time savings had we extended it to additional courses. The initial formation of a cross-institutional collaboration required substantial resources that offset some of the benefits of decreased faculty time in the present study. However, it is possible that the large up-front cost of this investment can be amortized across future shared courses, with a much lower expense required to maintain the existing collaboration infrastructure. This is analogous to the initial cost of building a modern simulation center—it represents a 1-time expense that is spread over years of subsequent SBT courses. Finally, specific barriers identified can be addressed which should improve the efficiency and ease of future curricula sharing.
Additional advantages of sharing SBT courses exist independent of the potential time savings. Collaboration allows the opportunity to improve and customize existing courses. Identifying faculty with shared interests across sites creates a potential network of future collaborators for course development and research. In addition, sharing courses disseminates one’s work to a wider audience, which may in turn count toward academic promotion.