Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education

Abstract

Introduction Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. Methods Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. Results After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. Conclusions Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care.

Impact of the COVID-19 pandemic on the clinical training of last year medical students in Mexico: a cross-sectional nationwide study

“…This type of curriculum could be an attractive alternative for low-income countries. It has the benefit of being low cost, [ 28 – 30 ] less time intensive for students and it can provide ample feedback from expert clinicians.…”

Simulation as an Improvement Technique

“…Nataraja et al report a significant national improvement in the management of paediatric intussusception (an acute bowel emergency) in Myanmar following the introduction of a focused, simulationbased intervention. 49 Preparing a disaster plan or evaluating strategies to minimise infections during a pandemic such as COVID-19 might involve computer…”

Long‐Term Impact of a Low‐Cost Paediatric Intussusception Air Enema Reduction Simulation‐Based Education Programme in a Low‐Middle Income Country

“…We have reported the beneficial short‐term effects of the AE reduction technique in Myanmar using SBE [12]. Our study meets a gap in the literature by reporting the long‐term clinical outcomes and exploring shifts in perceptions towards SBE in a LMIC [13].…”