Teaching the Principles of Pediatric Critical Care to Non-Intensivists in Resource Limited Settings: Challenges and Opportunities

Canarie, Michael F.; Shenoi, Asha

doi:10.3389/fped.2018.00044

Cited by 9 publications

(15 citation statements)

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“…Given that improved critical care outcomes are possible outside of the ICU [19; 27, 28] and given the dearth of ICU physician presence in Haiti and other LMICs, ramping up critical care education and training for non-ICU clinicians and nurses is crucial. Structured critical care training can reduce adult [29] and pediatric ICU mortality in LMICs [30–32]. While Haiti has no dedicated postgraduate critical care training program, its only existing Emergency Medicine residency program provides critical care instruction [33].…”

Section: Discussionmentioning

confidence: 99%

Critical care capacity in Haiti: A nationwide cross-sectional survey

et al. 2019

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Objective Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. Design Nationwide, cross-sectional survey of Haitian hospitals in 2017–2018. Setting Haiti. Subjects All Haitian health facilities with at least six hospital beds. Interventions Electronic- and paper-based survey. Results Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. Conclusions Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Critical care capacity in Haiti: A nationwide cross-sectional survey

et al. 2019

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“…PFCCS was developed by pediatric critical care leaders from the Society of Critical Care Medicine and can be administered through traditional live, in person course or online. The course has been successfully run internationally by 30 institutions; however, the course must be administered by trained, certified instructors (rather than train the trainer) and the cost can be prohibitive ( 37 ). ETAT is a comprehensive training for healthcare workers practicing pediatric emergency care in low resource settings that is available for free online or with in person courses (offering hands-on or screen based simulation options).…”

Section: Trainingmentioning

confidence: 99%

Pediatric Critical Care in Resource Limited Settings—Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations

et al. 2022

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Pediatric critical care has continued to advance since our last article, “Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned” was written just 3 years ago. In that article, we reviewed the history, current state, and gaps in level of care between low- and middle-income countries (LMICs) and high-income countries (HICs). In this article, we have highlighted recent advancements in pediatric critical care in LMICs in the areas of research, training and education, and technology. We acknowledge how the COVID-19 pandemic has contributed to increasing the speed of some developments. We discuss the advancements, some lessons learned, as well as the ongoing gaps that need to be addressed in the coming decade. Continued understanding of the importance of equitable sustainable partnerships in the bidirectional exchange of knowledge and collaboration in all advancement efforts (research, technology, etc.) remains essential to guide all of us to new frontiers in pediatric critical care.

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“…18 In any training fi eld in resource-limited settings, initial training with consistent reinforcement shows the most significant benefits. 19 A recent systematic review evaluating the train-the-trainer model for dissemination of short-term resuscitation courses established clear evidence that train-the-trainer programs improve provider knowledge and skills; however, its impact on patient outcomes and its long-term sustainability was not clear. 20 Thus, sustainability is not inherent within this model, but regular evaluation and follow-up may be required to support long-term quality improvement.…”

Section: Train the Trainermentioning

confidence: 99%

“…Evidence on program evaluation is lacking in healthcare development efforts in resourcelimited settings due to resource limitation and lack of awareness of evaluation benefi ts. 7,19,50 Program evaluations that have been documented include the utilization of student feedback and patient outcomes. There is also evidence that formative evaluations (those completed throughout a course) and summative evaluations (those completed at the completion of a course) are both benefi cial.…”

Section: ■ Program Evaluationmentioning

confidence: 99%

“…When implementing a new education initiative, identifying relevant outcome measures and gathering data are essential aspects of assuring future relevance and effectiveness of work. 19 ■ Emerging trends in the era of COVID-19 While evidence on the creation of sustainable education programs is limited, the number of health professional training initiatives has signifi cantly increased over the last 15 years, so more research may begin to surface. 8 The COVID-19 pandemic has highlighted the need for implementing even more education efforts and partnerships.…”

Section: Continual Feedback and Ongoing Adjustmentsmentioning

confidence: 99%

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