Blood safety training: Can virtual training replace in-person training?

INTRODUCTION

The WHO recommends providing safe and adequate blood and human resource training for blood safety and availability.¹ The National Blood Policy of India also incorporated training programmes for all health professionals to strengthen transfusion services.² Continuous professional development (CPD) and training are required to improve current knowledge and performance³ to prevent or minimize blood transfusion errors. The United Kingdom (UK) annual serious hazards of transfusion (SHOT) 2020, reported 81.6% all preventable and 6.1% possibly preventable events.⁴ The SHOT 2020 reported 19.9% of preventable errors from the laboratory including 2 preventable deaths and 35.9% of preventable morbidities and recommended clinical and laboratory staff training to achieve better patient safety.⁴ The novel Coronavirus-19 (Covid-19) pandemic resulted in a nationwide lockdown, which affected in person medical education worldwide^5,6 and resulted in a shift from traditional education methods to online or virtual methods.⁷

Our department is one of 26 training centres identified to provide training to strengthen transfusion services in India involving doctors, technicians, counsellors, nurses, and donor motivational organizations.⁸ We were providing in-person training to Karnataka state’s blood centre staff, which was halted due to the Covid-19 pandemic in India in March 2020. The subsequent second and third waves of Covid-19 infection in India necessitated us to plan a virtual blood safety training programme. We analysed the effectiveness and perception of participants towards the virtual training programme on blood safety at our centre.

METHODS

We did an analysis of pre-test and post-test responses to a 25-item multiple choice questionnaire and the feedback received about the training. A 5-day training programme was scheduled for all blood centres across Karnataka for all categories of staff in March 2022. During the training period, 20 procedural videos were created for all sections of transfusion services. The training programme presentations (PPTs) and demonstration videos were based on the National Blood Transfusion Council (NBTC) training modules, Government of India. The trainers had 15 years of association with the NBTC blood safety training programme.

RESULTS

The Karnataka state has 230 licensed blood centres, including 43 government, 8 Indian red cross society, 108 private hospital-based and 71 standalone charitable blood centres.⁹ A total of 293 participants registered for this training programme, including 82 doctors, 183 technicians, 12 nurses and 6 counsellors. The participation varied between 150 and 243 for various sessions and for both the tests (Table I). A total of 131 participants who had attempted both pre-test and post-test assessments were evaluated.

Assessment of training

The mean pre-test score of 131 participants was 16.02, and increased to 18.06 after the training programme (Fig. 1). The difference was not statistically significant. The mean pre-test and post-test scores for doctors (n=45) were 17.91 and 19.33, respectively. The difference was statistically significant (p<0.05). There was no statistically significant difference between the mean pre-test (15.03) and post-test (17.39) assessment scores of technical staff (n=86).

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FIG 1.

Traning assessment of the participants

Export to PPT

DISCUSSION

Training staff and upgrading them with the latest technology was one of the prerequisites for the WHO action framework in 2020–2023.¹⁰ This training aimed to provide reasonable knowledge about transfusion services.¹¹ The Covid-19 pandemic necessitated a change from traditional in-person to virtual training.^5,12 This blood safety training was focused on enhancing the participants’ laboratory skills through virtual videos. Brief tutorial videos evolved from social media platforms into formal resources to provide detailed training.¹³ The virtual training enabled us to involve many participants with minimal cost (total expenditure of US$ 4000) and to reduce training costs and optimize the utilization of limited human resources.¹⁴

The training evaluation based on pre, and post-test assessment showed improvement in staff scores but was statistically significant only for doctors who can perform better with virtual training compared to novice technical staff.¹⁵ Technical staff’s training and skill development are much dependent on the individual institute/hospital training. There are PG training programs (MD/DNB transfusion medicine) for doctors working in transfusion services.¹⁶ which might have helped doctors to discern important information from less important, resulting in more effective learning.¹⁵ Prolonged virtual training session may also be one reason for the poor performance of technical staff and comparable with Cowan et al.¹² Previously, the sole dependency on e-learning for practical courses was viewed as inadequate.^5,7,17

Similarly, approximately 80% of respondents in a survey considered it difficult to acquire clinical skills through distant e-learning.¹⁸ This may also have contributed to the technical staff’s performance. A high degree of self-discipline is a must for completing a virtual program.¹⁹ Absence from training program and other factors, like simultaneous involvement of blood centre staff for Covid-19-related hospital work and attending outstation blood collection drives, also contributed to the same.

There were limitations to this study. The training was evaluated only for level two of Kirkpatrick’s²⁰ four levels of evaluation. The low participation, multiple-choice questionnaire, and absence of practical exercise-based evaluation are limited options for the competency-based assessment of skills during virtual sessions.⁵ Potential biases such as participants’ prior knowledge and experience on the topic, their previous exposure to blood centres, and familiarity with similar topics in physical settings can impact the outcome of the study and these limitations were not taken in account while preparing the study design and methodology.