Elizabeth McLeod

Introduction: Healthcare workers in the Pacific Islands are distributed across many geographically remote areas. Online learning has significant potential to increase the accessibility of education; however, little is known about its use in this region. The primary aim of this review was to investigate the distribution and effectiveness of online learning for Pacific Island healthcare workers, information that may be useful to inform future online educational practices to maximise their outcomes. Methods: The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (ID: CRD42024502877). Six databases and two grey literature sources were searched over a 22-year period (2003–2025). Data were collected relating to learner populations, learning features, learning methods and outcome evaluation. Results were analysed and presented with descriptive statistics and narrative synthesis. Results: After retrieving 12,091 records, 42 studies were included. Learners were most often from Fiji (38%) or Vanuatu (31%), and the most prevalent groups were doctors (55%) and nurses (48%). Frequently used learning methods were lecture/seminar/conference (62%) and modular learning (36%). Where reported, learning approaches were balanced between asynchronous (31%), synchronous (29%) and mixed (31%). Twenty-six studies conducted outcome evaluation (62%), while eight programs (18%) analysed improvements using statistical methods. Thirty studies (71%) were published from 2021–2025. Conclusions: Online learning for healthcare workers has been increasingly used in the Pacific Islands. However, few studies conducted comprehensive evaluations, which limits conclusions regarding effectiveness. Publications often reported learning methods in limited detail. More robust research is needed to realise the full potential of online learning in the Pacific Islands.

Growing emphasis has been placed on the importance of local authorship in research from low and middle-income countries (LMICs). This study aimed to investigate local authorship of simulation-based education research conducted in LMICs through an in-depth authorship analysis of publications retrieved from a systematic review. After retrieving 27,738 records, 97 studies from 50 LMICs were included. The median number of authors was 8, ranging was from 2 to 18. Ninety-three studies (95%) included a local author, and local authors composed 145/291 (49%) of the total first, second, or final (FSF) authorship positions. Although there was a substantial increase in the number of published studies, there were no significant changes to the proportion of local FSF authors over time: 44% in 2002-2006; 63% in 2007-2011; 47% in 2012-2016; and 49% in 2017-2022 ( P = 0.45). The representation of local FSF authors is lower compared with other fields, though this may be reflective of including only studies that conducted high-level evaluation, or the fact that simulation is a relatively new field. Simulation researchers should actively support and include local authors to ensure programs are appropriate, contextualized and impactful, while making concerted efforts to develop local research capacity in LMICs.

The collection of clinical audit data are important for audit, research and other quality improvement processes. Low- and middle-income countries (LMICs) face a range of challenges to effective data collection and use. In this study, we explored factors affecting the collection of clinical data at a tertiary centre in Papua New Guinea. This qualitative study was based on semi-structured individual interviews with healthcare workers at a tertiary hospital in Papua New Guinea. Questions focused on participants' experiences and perspectives regarding the collection of clinical data. We transcribed the interviews and analysed them using reflexive thematic analysis. We collected demographics using a short survey. Reporting of the research was guided by COREQ. We conducted 20 interviews with predominantly nursing staff (n/N = 15/20; 75%). Of the participants, 16/20 (80%) had previously collected data for an audit or research project. Five themes and eight subthemes were conceptualised. Themes related to organisational culture, staff workload, data documentation practices, research infrastructure and study procedures. Although participants were motivated to complete data collection, they faced significant challenges that hindered their ability to do so. While staff often had to choose between collecting data and providing patient care, data collection initiatives could also improve patient care by improving communication between healthcare workers. In this study, we revealed numerous factors which affect the success of clinical data collection for audit and research purposes. These factors may be considered in the design of future initiatives. This has significant implications given the public health importance of strengthening data collection in Papua New Guinea, the Pacific Islands and LMICs in other regions.

Background: The World Health Organization (WHO) recommends simulation‐based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE.Methods: This was a cross‐sectional survey of Pacific Island healthcare workers. We designed an online questionnaire based on existing literature and expert consultation. The questionnaire included Likert scales, multiple‐choice, multi‐select and open‐ended questions. Participants were healthcare workers recruited from professional networks across the region. Descriptive statistics and relative frequencies summarized data, and comparative testing included unpaired t‐tests, Mann–Whitney U, Chi‐squared and Fisher's exact tests. Free‐text responses were presented to illustrate findings.Results: Responses from 56 clinicians working in 11 Pacific Island countries were included. Fifty were medical doctors (89%), including 31 (55%) surgeons. Participants reported experience with scenario‐based simulation (73%), mannequins (71%), and simulated patients (61%). Discrepancies were identified between previous simulation experience and current access for simulated patients (P = 0.002) and animal‐based part‐task trainers (P = 0.002). SBE was seen as beneficial for procedural skills, communication, decision‐making and teamwork. Interest in further SBE was reported by most participants (96%). Barriers included equipment access (59%), clinical workload (45%) and COVID‐19 restrictions (45%).Conclusion: Some Pacific Island healthcare workers have experience with SBE, but their ongoing access is predominantly limited to low‐technology modalities. Despite challenges, there is interest in SBE initiatives. These findings may inform planning for SBE in the Pacific Islands and may be considered prior to programme implementation.

Background: Simulation‐based education (SBE) has been increasingly used to train healthcare workers in low‐resource settings and has been endorsed by the World Health Organization (WHO). Consideration of the educational and cultural context is important to maximize the effectiveness of SBE. Despite its demonstrable benefits, there have been no studies of the general approach in the Pacific Islands. This study aimed to determine the factors that influence the uptake and success of SBE in the Pacific Islands.Methods: In this qualitative study, participants were recruited via professional networks to contribute to focus groups. Questions focused on participants' previous experiences and perspectives on SBE. Data were manually transcribed before thematic analysis. The reporting of the research was guided by the Standards for Reporting Qualitative Research (SRQR). Human Research Ethics Committee approval was obtained.Results: Two focus groups were conducted with 16 participants from six Pacific Island countries. Six themes and 15 subthemes were conceptualized from the data. Uptake of SBE is challenged by resource availability, clinical workloads and geographic remoteness. However, locally‐driven solutions and positive attitudes towards SBE facilitate its success.Conclusion: This study reveals the complexity of factors affecting the uptake and success of SBE in the Pacific Islands. These findings can serve to optimize the impact of existing and future SBE programmes and may be considered by educators prior to programme implementation.

Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high‐quality evaluation. This review provides a framework for conducting outcome evaluation of simulation‐based education programmes in low and middle‐income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation‐based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower‐middle‐income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed‐methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low‐resource settings to evaluate their own activities.

Background: The unmet global burden of surgical disease is substantial. The Lancet Commission on Global Surgery (LCoGS) estimated that 5 billion people do not have access to safe, affordable and timely surgical care, with 80% of those without access living in low‐ and middle‐income countries. The Milne Bay Province (pop 331 000) of Papua New Guinea, with an archipelago of islands up to 750 km from its capital, Alotau, has only one hospital capable of performing Caesarean Section, Emergency Laparotomy and managing an open fracture, the three Bellwether procedures. This paper aims to report the six Lancet Commission on Global Surgery metrics for Milne Bay Province.Methods: The study was conducted between January and August 2019. Bellwether access was investigated by a prospective study on 115 patients presenting to hospital. The surgical, anaesthesia and obstetric (SAO) workforce, surgical volume and perioperative mortality rate, were calculated for 2012–2018 from hospital records and operation registers. Financial risk metrics were calculated by surveying 50 patients at discharge from hospital.Results: Bellwether access: Only 27.8% (n = 32) of the study population (n = 115) experienced less than 2‐hours second delay (journey time to hospital). The average SAO provider density was 1.8 per 100 000 population. There were 606 procedures performed per 100 000 with a mean annual perioperative mortality rate of 0.3%. Catastrophic expenditure is a risk for 29% of the population.Conclusion: Milne Bay Province can perform surgery safely, but there is limited access to timely surgical care when needed with a significant proportion put at financial risk by requiring it.