Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces

Acker, Peter; Newberry, Jennifer A; Hattaway, Leonard Bud F; Socheat, Phan; Raingsey, Prak Piseth; Strehlow, Matthew

doi:10.7759/cureus.656

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Few pediatric-specific emergency care courses exist in LMICs. In Cambodia, which lacks a formal EMS, a group created a prehospital training course geared toward physicians who run the ambulances 36 . Unlike our course, the focus was on teaching prehospital emergency skills and did not include background anatomy and physiology.…”

Section: Discussionmentioning

confidence: 99%

“…In Cambodia, which lacks a formal EMS, a group created a prehospital training course geared toward physicians who run the ambulances. 36 Unlike our course, the focus was on teaching prehospital emergency skills and did not include background anatomy and physiology. The effectiveness of this course is difficult to discern because of the inconsistent delivery of written and skills examinations.…”

Section: Discussionmentioning

confidence: 99%

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Developing Sustainable Prehospital Pediatric Care in Rwanda

et al. 2022

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Objective: Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in lowand middle-income countries.Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda.Methods: A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course.Results: Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed paired t test, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%, P < 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45, P = 0.2357).Conclusions: This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Developing Sustainable Prehospital Pediatric Care in Rwanda

et al. 2022

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“…HBB has published an evaluation of their OSCE including item difficulty, discrimination and item agreement (Seto et al 2017). In contrast, administration of the pre-and post-knowledge test and OSCEs after the Prehospital Care Provider training in Cambodia was inconsistent, therefore, no comparisons were possible between the 58 courses (Acker et al 2016).…”

Section: Kirkpatrick Level Twomentioning

confidence: 99%

A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76

et al. 2022

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BackgroundTraining a skilled healthcare workforce is an essential part in reaching the United Nations Sustainable Development Goal to end preventable deaths in children and neonates. The greatest burden of mortality lies in low and lower-middle income countries (LLMIC). Short term, in-service courses have been implemented in many LLMIC to improve the quality of care delivered, but the evaluation methods of these courses are inconsistent. MethodStudies describing evaluations of course and outcome measures were included if the course lasted seven days or less with postgraduate participants, included paediatric or neonatal acute or emergency training and was based in a LLMIC. This narrative review provides a detailed description of evaluation methods of course content, delivery and outcome measures based on "Context, Input, Process and Product" (CIPP) and Kirkpatrick models. Results5265 titles were screened with 93 articles included after full-text review and quality assessment. Evaluation methods are described: context, input, process, participant satisfaction, change in learning, behaviour, health system infrastructure and patient outcomes. ConclusionsOutcomes, including mortality and morbidity, are rightly considered the fundamental aim of acute-care courses in LLMIC. Course evaluation can be difficult, especially with low resources, but this review outlines what can be done to guide future course organisers in providing well-conducted courses with consistent outcome measures for maximum sustainable impact. Keywords paediatric; neonatal; postgraduate; education; low-resource Practice Points• It is vital course evaluation is performed at a high standard. Structuring outcome measures using the CIPP and Kirkpatrick models will provide evidence of course effectiveness. • The diversity of outcome evaluations in this review displays what can be done in LLMIC where there is a range of resources available for this work. • There is a need for detailed description of the acute-care course, including justifying context and content with site-specific data, incorporating the local language and the support of local or national organisations for sustainability. • Publication by LLMIC authors must be facilitated to fully understand the appropriateness and impact of these courses in their context.

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“…During the project, this course was provided to over 900 providers at 38 referral hospitals within the project's target provinces. 32…”

Section: Lack Of Trained Ambulance-care Providersmentioning

confidence: 99%

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

Acker¹,

Matheson²,

Tuon³

et al. 2019

Journal of Global Health Reports

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Background Background Many factors align to reduce access to quality emergency services in Cambodia, resulting in unnecessary morbidity and mortality among the country's most vulnerable populations. The lack of a well-coordinated emergency referral system acts as a critical barrier for many seeking emergency care, limiting overall referral frequency and quality. To increase the effectiveness of the Cambodian healthcare system, the Quality Health Services (QHS) project implemented a spectrum of targeted, low-cost, locally-tailored interventions, including: triage systems, provincial clinical guidelines and referral hotlines, standardized referral-communication slips, and referral-feedback forms. To inform future health-system-strengthening efforts, the primary aim of this study is to describe the challenges facing the Cambodian referral system and the interventions applied to address these challenges. Secondarily, this study aims to characterize the frequency of emergency referrals in the post-intervention period and the utilization patterns of the implemented referral-system-strengthening tools. Methods Methods Data was collected prospectively on a quarterly basis at 35 government referral hospitals in six Cambodian provinces between March 2016 and June 2017, data from 25 of these facilities was analyzed. Data on overall numbers of referrals was collected from each facility's referral logbook. The frequency and thoroughness of standardized referral-communication slip and standardized referral-feedback form use was ascertained by reviewing copies of these tools collected at each facility during the preceding quarter. Results Results The average number of emergency referrals to target facilities increased from 114.4 to 190.4 per quarter, a 66% increase. Target facilities also received 86% more standardized referral-communication slips and sent 200% more standardized referral-feedback forms per quarter during the monitoring period. Conclusions Conclusions After receiving a package of referral-system-strengthening interventions the 25 hospitals analyzed in this study noted a significant increase in the frequency of emergency referral receipt. The frequency and quality of referral related communication improved consistently during the observation period as well. This data suggests that the interventions implemented addressed ongoing gaps in the Cambodian health system, and improved access to emergency referrals. These developments create a foundation upon which to build future health system strengthening interventions can be built and may provide guidance to implementors in other similarly resourced settings. During the late 1970's, under the rule of the Khmer Rouge, the Cambodian medical system was dismantled, and the country's health workforce decimated. Although the Khmer Rouge were ousted from Phnom Penh in 1979, violence and political unrest continued for many years, draining aid resources and hindering reconstruction efforts. As a result, during the 1980's and early 1990's, the country suffered some of the worst...

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Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces

Cited by 3 publications

References 6 publications

Developing Sustainable Prehospital Pediatric Care in Rwanda

Developing Sustainable Prehospital Pediatric Care in Rwanda

A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

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