Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6349 D1, Baltimore, MD, 21287, USA.
Department of Pediatric Critical Care, Philippine Children's Medical Center, Quezon City, Philippines.
BMC Med Educ. 2022 Aug 5;22(1):606. doi: 10.1186/s12909-022-03669-0.
Shock causes significant morbidity and mortality in children living in resource-limited settings. Simulation has been successfully used as an educational tool for medical professionals internationally. We sought to improve comfort and knowledge regarding shock recognition and fluid management by implementing a pediatric shock curriculum using simulation as an assessment for trainees in Manila, Philippines.
We assessed a shock curriculum focused on patients with malnutrition in a prospective cohort study, using a written test and a videotaped simulation-based objective standardized clinical examination. Implementation occurred in March 2020 with 24 Filipino pediatric residents at a single institution in Manila. Outcomes included time to initiation of fluid resuscitation, improvement in confidence, knowledge on a written assessment, and performance in simulation. Results were compared pre- and post-intervention using Wilcoxon signed-rank test.
The time to initiation of fluids did not change between the baseline simulation (median [interquartile range] = 71.5 seconds [52-116.5]) and the final simulation (68 seconds [52.5-89]; P = 0.42). Confidence in identifying shock and malnutrition, managing hypovolemic shock, managing septic shock, and placing intraosseous access all increased (P < 0.01) post-intervention. Written test scores showed no improvement, but performance in simulation, measured using a checklist, improved from a total score of 10 [8.5-11] to 15 [13-16] (P < 0.01).
In our study of a simulation-based shock education program, we showed improvement in confidence and knowledge as measured by a resuscitation checklist. It is feasible to establish a successful simulation-based education program in a low-resource setting.
在资源有限的环境中，休克会导致儿童出现大量发病率和死亡率。模拟已成功用作国际医疗专业人员的教育工具。我们旨在通过在菲律宾马尼拉实施使用模拟作为培训师评估的儿科休克课程，提高对休克识别和液体管理的舒适度和知识。
我们在一项前瞻性队列研究中评估了针对营养不良患者的休克课程，使用书面测试和基于视频的模拟客观标准化临床检查。该实施于 2020 年 3 月在马尼拉的一家单一机构进行，共有 24 名菲律宾儿科住院医师参与。结果包括液体复苏的起始时间、信心的提高、书面评估的知识和模拟的表现。使用 Wilcoxon 符号秩检验比较干预前后的结果。
在基线模拟（中位数[四分位距] = 71.5[52-116.5]）和最终模拟（68 秒[52.5-89]；P = 0.42）之间，开始补液的时间没有变化。在干预后，识别休克和营养不良、管理低血容量性休克、管理脓毒性休克以及放置骨髓内通路的信心均有所提高（P < 0.01）。书面测试成绩没有提高，但使用检查表衡量的模拟表现从总分为 10[8.5-11]提高到 15[13-16]（P < 0.01）。
在我们的基于模拟的休克教育计划研究中，我们显示出信心和知识的提高，这是通过复苏检查表来衡量的。在资源有限的环境中建立成功的基于模拟的教育计划是可行的。
