Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Feasibility of Simulation-Based Medical Education in a Low-Income Country

Challenges and Solutions From a 3-year Pilot Program in Uganda

Bulamba, Fred, MMed; Sendagire, Cornelius, MMed; Kintu, Andrew, MMed; Hewitt-Smith, Adam, MBBS; Musana, Fred, MMed; Lilaonitkul, Maytinee, MBBS; Ayebale, Emmanuel T., MMed; Law, Tyler, MD; Dubowitz, Gerald, MB ChB; Kituuka, Olivia, MMed; Lipnick, Michael S., MD

doi: 10.1097/SIH.0000000000000345
Special Article

Summary Statement Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context-appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.

From the Department of Anesthesia (F.B., A.H.S., F.M.), Faculty of Health Sciences, Busitema University, Tororo; Department of Anesthesia and intensive care (C.S.), Uganda Heart Institute; Department of Anesthesia (A.K., E.T.A.), College of Health Sciences, Makerere University, Kampala, Uganda; Department of Anesthesia and Perioperative Care (M.L., M.S.L., T.L., G.D.), University of California at San Francisco, San Francisco, California; and Department of Surgery (O.K.), College of Health Sciences, Makerere University, Kampala, Uganda.

Reprints: Fred Bulamba, MMed, Faculty of Health Sciences, Busitema University, PO Box 1640, Mbale, Uganda (e-mail:;

The authors declare no conflict of interest.

This work is attributed to Makerere University College of Health Sciences, Department of Anesthesia, Kampala, Uganda, and Busitema University Faculty of Health Sciences, Department of Anesthesia.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2019 Society for Simulation in Healthcare