Bowling Morgan, Langer Samantha, Saracino Christine, Shrestha Roshana, Joshi Anish, Kutzin Jared, Strother Christopher, House Darlene R
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Int J Emerg Med. 2025 Jul 1;18(1):116. doi: 10.1186/s12245-025-00928-x.
Pediatric Emergency Medicine (PEM) remains underdeveloped in low- and middle- income countries, such as Nepal. Among other limitations, there is a paucity of certification programs, such as Pediatric Advanced Life Support (PALS), and pediatric specific education curricula available to local providers. Low-fidelity simulation is an effective educational tool to improve providers' comfort with skills specific to the care of critically ill children. Our objectives were twofold. Firstly, to certify a pilot group of providers in PALS. Secondly, using the Kern's Model of Curriculum Development, we designed, implemented, and evaluated a contextualized simulation-based curriculum for preparing medical providers at Dhulikhel Hospital, an independent, not-for-profit academic hospital in Nepal, with the necessary skills to approach common pediatric emergencies.
Medical professionals who care for pediatric patients at Dhulikhel Hospital were included in our PALS and simulation-based training. Simulation cases were based on local needs assessment of the common pediatric emergency conditions, which included four scenarios: respiratory distress, status epilepticus, precipitous preterm delivery, and organophosphate poisoning. Participants completed anonymous pre- and post-simulation surveys regarding their comfort level with performing specific procedures and managing scenarios. Standardized pre-and-debriefing discussions were held. Key procedures were practiced after the simulations using hands-on skills stations. A 3-month post-course survey was conducted to assess retention of confidence.
Thirty-seven providers participated in the course. 54% (n = 20) had never participated in simulation prior. All questions showed a statistically significant difference in provider comfort. Provider comfort increased after implementation of low-fidelity simulation-based learning, with an emphasis on specific procedure training. A smaller difference was seen in tasks in which providers were already familiar, such as obtaining a history. The questions with the greatest difference in provider comfort directly corresponded to topics involving a skills station. The 3-month post-course survey demonstrated overall consistency with maintained comfort levels.
Low-fidelity simulation is effective and should be implemented in low- and middle- income countries, specifically with high acuity but lower occurrence skills, like intraosseous and umbilical line placement. As specialized PEM training expands, dedicated pediatric training courses and simulation-based learning can improve provider comfort with fundamental procedures to improve the outcomes of pediatric patients.
在尼泊尔等低收入和中等收入国家，儿科急诊医学（PEM）仍不发达。除其他限制因素外，当地医疗人员缺乏诸如儿科高级生命支持（PALS）等认证项目以及儿科特定教育课程。低保真模拟是一种有效的教育工具，可提高医疗人员对危重症儿童护理特定技能的熟练度。我们有两个目标。其一，为一组试点医疗人员进行PALS认证。其二，我们采用克恩课程开发模型，设计、实施并评估了一门基于情境模拟的课程，以让尼泊尔独立的非营利性学术医院杜利凯尔医院的医疗人员具备应对常见儿科急诊的必要技能。
在杜利凯尔医院护理儿科患者的医疗专业人员参加了我们的PALS和基于模拟的培训。模拟案例基于对常见儿科急诊情况的当地需求评估，包括四种场景：呼吸窘迫、癫痫持续状态、急产早产和有机磷中毒。参与者完成了关于他们执行特定程序和处理场景的舒适度的匿名模拟前和模拟后调查。进行了标准化的模拟前和模拟后讨论。模拟后在实践技能站练习关键程序。在课程结束3个月后进行了一项调查，以评估信心的保持情况。
37名医疗人员参加了该课程。54%（n = 20）的人此前从未参加过模拟。所有问题在医疗人员的舒适度方面均显示出统计学上的显著差异。在实施基于低保真模拟的学习后，医疗人员的舒适度有所提高，重点是特定程序培训。在医疗人员已经熟悉的任务（如获取病史）中，差异较小。医疗人员舒适度差异最大的问题直接对应于涉及实践技能站的主题。课程结束3个月后的调查显示总体一致性以及舒适度的保持。
低保真模拟是有效的，应在低收入和中等收入国家实施，特别是对于高难度但发生率较低的技能，如骨髓内和脐静脉置管。随着专业PEM培训的扩展，专门的儿科培训课程和基于模拟的学习可以提高医疗人员对基本程序的舒适度，从而改善儿科患者的治疗效果。
