Glomb Nicolaus W, Rus Marideth C, Kosoko Adeola Adekunbi, Saha Sharmistha, Murphy Kristen, Doughty Cara B, Galapi Cafen, Laba Bushe, Shah Manish I
University of California, San Francisco, Department of Emergency Medicine, San Francisco, CA.
Baylor College of Medicine, Department of Pediatrics, Houston, TX.
J Educ Teach Emerg Med. 2021 Jul 15;6(3):C64-C189. doi: 10.21980/J8306S. eCollection 2021 Jul.
This simulation-based training focuses on the most common and high risk pediatric prehospital scenarios in low- and middle-income countries (LMIC). The curriculum was developed based on a needs assessment to train Ministry of Health and Wellness (MOHW) prehospital providers in Botswana specifically for pediatric resuscitation and could be used for emergency medical services (EMS) providers in other LMIC. After participating in this curriculum, providers should enhance their assessment and interventions in acutely ill pediatric prehospital patients.
The entire course was designed to be presented over two days with 6-8 hours of instruction each day.
In recent years, prehospital medicine has shown continued growth in LMICs, specifically in Sub-Saharan Africa. As these programs develop focused training for the pediatric population, equipping the workforce with pediatric resuscitation skills is essential. A few years after its inception, the Botswana MOHW identified deficiencies in their current training program and sought external expertise and educational training. We partnered with the MOHW to create and implement a novel, prehospital simulation curriculum to teach pediatric resuscitation to prehospital providers. Our aim was to create a curriculum based on the needs of the community that could also be implemented in other similar resource-limited settings. This course included didactic sessions, five simulation scenarios using low fidelity mannequins and three pediatric-focused skill sessions. This program was found to be effective based on statistically significant improvement in written and simulation post-test scores.
The objective of this educational project was to design, implement, and evaluate a curriculum relevant to an EMS system based in a LMIC, so that it could be a basis for curricula for use in similar contexts. The educational goal is to improve prehospital providers performance in common pediatric resuscitations.
The educational methods used in this curriculum included simulation using rapid cycle deliberate practice (RCDP), didactic lectures, and hands on skills training for common pediatric scenarios. Outcomes were measured by comparing performance on written and simulation-based pre-and post-tests.
Participants completed written and simulation-based pre- and post-tests covering the concepts taught in the curriculum. Continuous variables (written and simulation test scores) were compared between two dependent groups (pre- and post-trainings) using paired t-tests.
Mean written test scores increased by 11%, from 75% to 86% (p<0.0001), while mean simulated test scores increased by 22% (from 56% to 78 % (p<0.0001).
The curriculum we developed focused on high-yield pediatric skills based on the needs of the Botswana MOHW EMS program. We believe simulation training was an excellent and effective method for this type of training. We specifically designed RCDP scenarios for the training, due to the limited experience of the prehospital providers at that time. RCDP offers ample opportunities for feedback with immediate practice and improvement. Trainees demonstrated retention of knowledge and improved performance in simulation-based testing. The overall satisfaction level of the trainees was high and suggests additional training would be beneficial and desired. Additionally, as the results of our needs assessment mirrored common chief complaints in other LMIC countries in Sub-Saharan Africa1,2 we feel that this curriculum can be utilized and adopted with minor modifications in other LMIC settings, particularly where EMS programs are developing and in circumstances where few EMS providers have had extensive field experience.
Respiratory distress, asthma, dehydration, hypovolemic shock, hypoglycemia, seizure, toxic ingestion, newborn resuscitation, precipitous delivery, traumatic injury, EMS, Botswana, global health, collaboration, rapid cycle deliberate practice (RCDP), medical simulation.
这种基于模拟的培训聚焦于低收入和中等收入国家（LMIC）最常见且高风险的儿科院前场景。该课程是基于一项需求评估开发的，旨在专门培训博茨瓦纳卫生与健康部（MOHW）的院前急救人员进行儿科复苏，也可供其他低收入和中等收入国家的紧急医疗服务（EMS）人员使用。参与本课程后，急救人员应加强对急性病儿科院前患者的评估和干预。
整个课程设计为分两天进行，每天授课6 - 8小时。
近年来，院前医学在低收入和中等收入国家持续发展，特别是在撒哈拉以南非洲地区。随着这些项目针对儿科人群开展针对性培训，使急救人员具备儿科复苏技能至关重要。博茨瓦纳卫生与健康部在其项目启动几年后，发现当前培训项目存在不足，于是寻求外部专业知识和教育培训。我们与卫生与健康部合作，创建并实施了一个新颖的院前模拟课程，向院前急救人员传授儿科复苏知识。我们的目标是创建一个基于社区需求的课程，该课程也可在其他类似资源有限的环境中实施。本课程包括理论授课、使用低保真人体模型的五个模拟场景以及三个以儿科为重点的技能环节。基于书面测试和模拟测试后测成绩的统计学显著提高，该项目被证明是有效的。
本教育项目的目标是设计、实施和评估一个与低收入和中等收入国家的紧急医疗服务系统相关的课程，使其能够成为在类似环境中使用的课程基础。教育目标是提高院前急救人员在常见儿科复苏中的表现。
本课程中使用的教育方法包括采用快速循环刻意练习（RCDP）的模拟、理论讲座以及针对常见儿科场景的实践技能培训。通过比较书面测试和基于模拟的课前和课后测试成绩来衡量学习成果。
参与者完成了涵盖课程中所教概念的书面测试和基于模拟的课前和课后测试。使用配对t检验比较两个相关组（培训前和培训后）的连续变量（书面测试和模拟测试成绩）。
书面测试平均成绩提高了11%，从75%提高到86%（p<0.0001），而模拟测试平均成绩提高了22%（从56%提高到78%，p<0.0001）。
我们开发的课程基于博茨瓦纳卫生与健康部紧急医疗服务项目的需求，聚焦于高收益的儿科技能。我们认为模拟培训是这类培训的一种优秀且有效的方法。由于当时院前急救人员经验有限，我们专门为培训设计了快速循环刻意练习场景。快速循环刻意练习提供了大量即时实践和改进的反馈机会。学员在基于模拟的测试中表现出知识的保留和成绩的提高。学员的总体满意度较高，表明额外的培训将是有益且受欢迎的。此外，由于我们的需求评估结果反映了撒哈拉以南非洲其他低收入和中等收入国家常见的主要投诉1,2，我们认为该课程稍作修改后可在其他低收入和中等收入国家使用，特别是在紧急医疗服务项目正在发展且很少有急救人员有丰富现场经验的情况下。
呼吸窘迫、哮喘、脱水、低血容量性休克、低血糖、癫痫、中毒、新生儿复苏、急产、创伤性损伤、紧急医疗服务、博茨瓦纳、全球健康、合作、快速循环刻意练习（RCDP）、医学模拟
