Pediatric Resuscitation Education in Low-Middle-Income Countries: Effective Strategies for Successful Program Development

Jung, Julianna; Shilkofski, Nicole

doi:10.1055/s-0036-1584673

Cited by 3 publications

(2 citation statements)

References 65 publications

(63 reference statements)

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“…Not surprisingly, scheduling participants and facilitators for a relatively brief training requiring travel while coordinating with facilities and equipment was a common challenge. Also, recruiting volunteers was difficult as a result of the inability to succinctly communicate the potential benefits of this training opportunity, overcome the perception that adequate education was being offered through existing training curriculum, and address skepticism regarding the novel educational modality, an obstacle that had been documented by other training programs 25 . The high levels of satisfaction may be the result of the strong technical support and the fidelity of the training, but they may also be biased by the motivation of the self-selected participants.…”

Section: Discussionmentioning

confidence: 99%

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

French¹,

DuBose-Morris²,

Lee³

et al. 2022

Southern Medical Journal

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Objectives: Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies.Methods: Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre-and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results.Results: A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training.Conclusions: This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.

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Section: Discussionmentioning

confidence: 99%

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

French¹,

DuBose-Morris²,

Lee³

et al. 2022

Southern Medical Journal

View full text Add to dashboard Cite

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“…The TTT model is attractive because it is inexpensive, enables rapid scale-up, and can increase local ownership of training [5]. However, few LMIC trauma courses demonstrate improvements in clinical outcomes [5][6][7]. Studies assessing trauma courses typically use surrogate measures such as standardized tests and self-reports, but these instruments may not reflect true practice of skills and are susceptible to response biases [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Clinical Practices Following Train‐The‐Trainer Trauma Course Completion in Uganda: A Parallel‐Convergent Mixed‐Methods Study

et al. 2023

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Background Despite the growth of trauma training courses worldwide, evidence for their impact on clinical practice in low- and middle-income countries (LMICs) is sparse. We investigated trauma practices by trained providers in Uganda using clinical observation, surveys, and interviews. Methods Ugandan providers participated in the Kampala Advanced Trauma Course (KATC) from 2018 to 2019. Between July and September of 2019, we directly evaluated guideline-concordant behaviors in KATC-exposed facilities using a structured real-time observation tool. We conducted 27 semi-structured interviews with course-trained providers to elucidate experiences of trauma care and factors that impact adoption of guideline-concordant behaviors. We assessed perceptions of trauma resource availability through a validated survey. Results Of 23 resuscitations, 83% were managed without course-trained providers. Frontline providers inconsistently performed universally applicable assessments: pulse checks (61%), pulse oximetry (39%), lung auscultation (52%), blood pressure (65%), pupil examination (52%). We did not observe skill transference between trained and untrained providers. In interviews, respondents found KATC personally transformative but not sufficient for facility-wide improvement due to issues with retention, lack of trained peers, and resource shortages. Resource perception surveys similarly demonstrated profound resource shortages and variation across facilities. Conclusions Trained providers view short-term trauma training interventions positively, but these courses may lack long-term impact due to barriers to adopting best practices. Trauma courses should include more frontline providers, target skill transference and retention, and increase the proportion of trained providers at each facility to promote communities of practice. Essential supplies and infrastructure in facilities must be consistent for providers to practice what they have learned.

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Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

Powell,

Echeto‐Cerrato,

Gathuya

et al. 2023

World j. surg.

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Background Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low-and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed. Methods A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions. Results and conclusions There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, largescale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.

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Pediatric Resuscitation Education in Low-Middle-Income Countries: Effective Strategies for Successful Program Development

Cited by 3 publications

References 65 publications

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

Clinical Practices Following Train‐The‐Trainer Trauma Course Completion in Uganda: A Parallel‐Convergent Mixed‐Methods Study

Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

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