Abstract
OBJECTIVES: To compare the acceptance, strengths and limitations of Simulation via Instant Messaging-Birmingham Advance (SIMBA) in low/middle-income countries (LMICs) and high-income countries (HICs), on healthcare professionals' professional development and learning. DESIGN: Cross-sectional study. SETTING: Online (either mobile or computer/ laptop or both). PARTICIPANTS: 462 participants (LMICs: 29.7%, n=137 and HICs: 71.3%, n=325) were included. INTERVENTIONS: Sixteen SIMBA sessions were conducted between May 2020 and October 2021. Doctors-in-training solved anonymised real-life clinical scenarios over WhatsApp. Participants completed pre-SIMBA and post-SIMBA surveys. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes were identified using Kirkpatrick's training evaluation model. LMIC and HIC participants' reactions (level 1) and self-reported performance, perceptions and improvements in core competencies (level 2a) were compared using the χ(2) test. Content analysis of open-ended questions was performed. RESULTS: Postsession, there were no significant differences in application to practice (p=0.266), engagement (p=0.197) and overall session quality (p=0.101) between LMIC and HIC participants (level 1). Participants from HICs showed better knowledge of patient management (LMICs: 77.4% vs HICs: 86.5%; p=0.01), whereas participants from LMICs self-reported higher improvement in professionalism (LMICs: 41.6% vs HICs: 31.1%; p=0.02). There were no significant differences in improved clinical competency scores in patient care (p=0.28), systems-based practice (p=0.05), practice-based learning (p=0.15) and communication skills (p=0.22), between LMIC and HIC participants (level 2a). In content analysis, the major strengths of SIMBA over traditional methods were providing individualised, structured and engaging sessions. CONCLUSIONS: Healthcare professionals from both LMICs and HICs self-reported improvement in their clinical competencies, illustrating that SIMBA can produce equivalent teaching experiences. Furthermore, SIMBA's virtual nature enables international accessibility and presents potential for global scalability. This model could steer future standardised global health education policy development in LMICs.