title: Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar.
abstract: BACKGROUND
  Myanmar has struggled through decades of internal conflict, which has negatively impacted the country's health outcomes. Recent government changes have brought hope and reduced conflict. The ethnic minority groups have suffered the brunt of the health consequences and reside in regions that lack health infrastructure, resources, and providers. Due to the chronic lack of healthcare providers within conflict areas, health workers (HWs) have been trained in an effort to fill the void. Research has shown that these non-physician clinicians positively impact health outcomes in developing countries. These HWs are supported by community-based organizations in collaboration with foreign non-governmental organizations. Started in 2000, the trauma training course was developed to meet the educational needs of these HWs.
  
  
  METHODS
  Essential procedures for HWs in conflict zones were identified, and teaching methods were adapted to develop models that were simple, reproducible, cost effective, and able to facilitate effective learning within the limitations of these challenging environments. This paper presents simulation models developed to teach trauma injury evaluation and management in resource-limited settings to HWs.
  
  
  RESULTS
  Material and construction of the models described include breathing, chest, cricothyroidotomy, circulation, wound repair, fracture/dislocation, splinting, fasciotomy/amputation, and an animal model. In 2013, a pre/post test and post-training evaluation were completed, which demonstrated an increase in understanding of the material and satisfaction with the training.
  
  
  CONCLUSIONS
  The simulation models described engage the HWs in clinical skills practice specific to injury management, which builds upon the HWs existing knowledge and facilitates an increased understanding of life-saving procedures. Through observation of the HW performance and HW feedback, these simulation models have increased the understanding of trauma management. Limitations include lack of a graduated learning system for the HWs, logistics, and time constraints. Despite the barriers faced, we feel that this is a necessary program that has reduced morbidity and mortality due to traumatic injury in the geographic areas that the HWs serve. With the changing political environment in Myanmar and the development of peace agreements between the government and the ethnic minority groups, these HWs can be integrated into Myanmar's evolving health system.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Washington
authors.affiliation: Access Aid International, PO box 6086, St Kilda Road, Melbourne, VIC 3004 Australia.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Tyler
authors.affiliation: Community Partners International, 2550 Ninth Street, Suite 111, Berkeley, CA 94710 USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Davis
authors.affiliation: Ross University School of Medicine, PO box 266, Roseau, West Indies Commonwealth of Dominica.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Shapiro
authors.affiliation: Division of General Internal Medicine & Health Services Research at UCLA, 911 Broxton Plaza, Los Angeles, CA 90024 USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Richards
authors.affiliation: David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Richard
authors.affiliation: David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lee
authors.affiliation: University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724 USA.
authors.forename: Taryn L
authors.initials: TL
authors.lastname: Colton
authors.affiliation: University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Berk
authors.affiliation: Antelope Valley Hospital, 1600 W Avenue J, Lancaster, CA 93534 USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Rauch
authors.affiliation: Karen Department of Health and Welfare, Mae Sot, Tak Province Thailand.
authors.forename: Eh Kalu
authors.initials: EK
authors.lastname: Shwe Oo
authors.affiliation: High Desert Health Systems, Los Angeles County Department of Health Services, 44900 60th Street West, Lancaster, CA 93536 USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Hahn
authors.affiliation: David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Stock
keywords: Conflict; Health worker; Myanmar; Simulation; Trauma training