Table 2 Understanding barriers and enablers of proposed intervention in line with the CFIR model

Intervention characteristics

Relative advantage

Learners do not have enough access to patients on some scenarios during normal teaching sessions on wards. Simulation allows learners to bridge this skills gap

Cost

Perceived barriers to implementation

There is concern whether the tools(manikins) for conducting simulation sessions are sufficient

Outer setting

Patient needs and resources

Understanding of medical simulation

Acknowledging simulation as one way to address patient safety

External policy and incentives

Key priority areas

The need for engaging higher authorities such as the ministries to gain approval and improve acceptability

Characteristics of individuals

Knowledge and beliefs about the intervention

Perceived benefits of PGs as simulation educators

Enhances near peer teaching by providing;

-Hands on skills

-Confidence when managing a case scenario

Attitudes towards simulation

May not give the actual picture as the real life scenario

Key priority areas

Training simulation facilitators

Inner setting

Implementation climate

Compatibility

Anticipated barriers Enablers

Scheduling of simulation sessions versus other competing demands for both post graduates and undergraduate students Flexibility to change-some departments are keen to embrace innovations in medical education

Tension for change

Perceived benefits of SBL

Current teaching limits practical opportunities for students thus the need for simulation

Organizational incentives and rewards

Key priority areas

Certification of simulation facilitators

Readiness for implementation

Leadership engagement

Key priority areas

The need for engaging heads of departments, faculty administrators and other university administration

Available resources

Key priority areas

Ensure there are sufficient teaching and learning materials

Space for conducting sessions

Schedule simulation sessions into existing timetable

Culture

Enablers

Departments are adaptable to change

Process

Engaging

Opinion leaders

Key priority areas

Bring the heads of department on board through sensitization

Reflecting and evaluating

Key priority areas

Concern as to whether there will be an undergraduate medical student comparison group that did not receive the intervention