1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Ann Am Thorac Soc. 2015 Apr;12(4):491-7. doi: 10.1513/AnnalsATS.201412-557AR.
The capacity to care for the critically ill has long been viewed as a fundamental element of established and comprehensive health care systems. Extending this capacity to health care systems in low- and middle-income countries is important given the burden of disease in these regions and the significance of critical care in overall health system strengthening. However, many practicalities of improving access and delivery of critical care in resource-limited settings have yet to be elucidated. We have initiated a program to build capacity for the care of critically ill patients in one low-income Southeast Asian country, Cambodia. We are leveraging existing international academic partnerships to enhance postgraduate critical care education in Cambodia. After conducting a needs assessment and literature review, we developed a three-step initiative targeting training in mechanical ventilation. First, we assessed and revised the current resident curriculum pertaining to mechanical ventilation. We addressed gaps in training, incorporated specific goals and learning objectives, and decreased the hours of lectures in favor of additional bedside training. Second, we are incorporating e-learning, e-teaching, and e-assessment into the curriculum, with both live, interactive and independent, self-paced online instruction. Third, we are developing a train-the-trainer program defined by bidirectional international faculty exchanges to provide hands-on, case-based, and bedside training to achieve competency-based outcomes. In targeting specific educational needs and a key population-the next generation of Cambodian intensivists-this carefully designed approach should address some existing gaps in the health care system and hopefully yield a lasting impact.
长期以来，照顾重症患者的能力一直被视为成熟和综合医疗保健系统的基本要素。鉴于这些地区的疾病负担以及重症监护在整体卫生系统强化中的重要性，将这种能力扩展到中低收入国家的医疗保健系统非常重要。然而，在资源有限的环境中改善重症护理的可及性和提供的许多实际问题仍有待阐明。我们已经启动了一个计划，为一个东南亚低收入国家柬埔寨的重症患者护理提供能力建设。我们正在利用现有的国际学术伙伴关系来加强柬埔寨的研究生重症监护教育。在进行需求评估和文献回顾后，我们制定了一项针对机械通气培训的三步骤计划。首先，我们评估并修订了目前与机械通气相关的住院医师课程。我们解决了培训方面的差距，纳入了具体的目标和学习目标，并减少了讲座的时间，转而增加床边培训。其次，我们正在将电子学习、电子教学和电子评估纳入课程，包括现场互动和独立的、自我指导的在线教学。第三，我们正在制定一项培训师培训计划，该计划由双向国际教师交流来提供实践、基于案例和床边培训，以实现基于能力的结果。通过针对特定的教育需求和关键人群——柬埔寨下一代重症监护医生——这种精心设计的方法应该能够解决医疗保健系统中现有的一些差距，并有望产生持久的影响。
