Challenges in implementing simulation-based training programme in managing sick surgical patients in India: A review

Background Formal skill-based critical care competency development for non-anaesthetists or non-intensivists is variable in India at the undergraduate and postgraduate levels. This review aims to understand the barriers to the implementation of a simulation-based acute critical care course (ACCC) for clinicians. Methods We reviewed published articles that consist essentially of qualitative data, although some quantitative data is also included. For the stratification of articles, three instruments were used for the critical appraisal of published literature: (i) Guba's four parameters, (ii) ConQual rating and (iii) critical appraisal of the study programme. Results To effect a change in enabling clinicians to manage deteriorating patients safely, it is crucial to equip them with the necessary skills (technical and non-technical). It is important to introduce simulation-based courses, such as ACCC, to enable undergraduate and postgraduate medical and surgical trainees to gain the right balance of competence and confidence in managing complex situations before specialists, who are experts in critical care, take over. Conclusion An executive decision made by those at the helm of medical training and monitoring is necessary in medical education at both the undergraduate and postgraduate levels. The regulatory authorities (National Medical Commission and State Medical Councils) have a responsibility to address a plethora of challenges in the implementation of a scientific approach to simulation-based training. Life-saving skill development, rather than lecture-based education, is the key to equipping all clinicians in managing patients who are at risk of dying.