Rotation Director, Global Health Elective Pediatric Residency Program, and Assistant Professor of Clinical Pediatrics, Weill Cornell Medical College.
Assistant Dean for Diversity and Student Life and Professor of Clinical Pediatrics, Weill Cornell Medical College.
MedEdPORTAL. 2023 Sep 1;19:11341. doi: 10.15766/mep_2374-8265.11341. eCollection 2023.
Pediatric residents are increasingly pursuing global health electives. Differences in cultural norms and management around pediatric deaths in resource-limited settings can be emotionally overwhelming for residents. Educational resources are needed to better equip them for handling these stressful situations. We developed a predeparture simulation child death case to prepare pediatric residents for their global health elective.
The simulation module included a clinical case followed by a multidisciplinary structured debriefing. The case featured a 5-year-old, malnourished child in hypovolemic shock who clinically deteriorates and dies. After obtaining a history and performing a physical examination, residents were expected to diagnose severe malnutrition, treat hypovolemic shock, and decide how far to extend resuscitation with the limited resources. Upon returning from abroad, residents were invited to complete a survey on the utility of the simulation case module in preparing for their elective.
Twenty-nine residents participated in the simulation case module, and 18 completed the survey. Seventeen agreed or strongly agreed that the simulation module was a useful tool for preparation ( = 4.5 on a 5-point Likert scale). Residents reflected that the simulation module helped manage expectations and provided them with an understanding of the cross-cultural differences in managing pediatric deaths in a resource-limited setting.
Pediatric residents trained in resource-rich countries do not encounter death often. Postgraduate training programs could consider simulations like this one to prepare such residents for cross-cultural differences in managing pediatric deaths and build resiliency to operate in resource-limited settings.
儿科住院医师越来越多地选择参加全球健康选修课程。在资源有限的环境中，文化规范和儿童死亡管理方面的差异可能会对住院医师造成情感上的冲击。需要教育资源来更好地装备他们，以处理这些紧张的情况。我们开发了一个出发前模拟儿童死亡案例，以帮助儿科住院医师为他们的全球健康选修课程做准备。
该模拟模块包括一个临床案例，随后是多学科结构化的汇报。案例的主角是一名 5 岁的营养不良、低血容量性休克的儿童，他的病情临床恶化并死亡。在获得病史并进行体格检查后，住院医师应诊断出严重的营养不良、治疗低血容量性休克，并决定在有限的资源下，将复苏延长到什么程度。从国外回来后，住院医师被邀请完成一份关于模拟案例模块在为选修课程做准备方面的效用的调查。
29 名住院医师参加了模拟案例模块，其中 18 人完成了调查。17 人同意或强烈同意模拟模块是准备的有用工具（ = 5 分制上的 4.5 分）。住院医师反映，模拟模块有助于管理期望，并让他们了解在资源有限的环境中管理儿科死亡的跨文化差异。
在资源丰富的国家接受培训的儿科住院医师并不经常遇到死亡。研究生培训项目可以考虑类似的模拟，为这些住院医师准备处理跨文化的儿童死亡差异，并建立在资源有限的环境中运作的适应力。
