Teaching Trauma in Resource‐Limited Settings: A Scoping Review of Pediatric Trauma Courses

Abstract

Purpose Injury remains an important cause of death and disability globally, with 95% of all childhood injury deaths occurring in low-and lower-middle-income countries (LMICs). Pediatric trauma training, tailored to the resources in LMICs, represents an opportunity to improve such outcomes. We explored the nature of course offerings in pediatric trauma in resource-limited settings. Methods Seven databases were interrogated up to June 12, 2020, to retrieve articles examining pediatric trauma training in LMICs, as defined by the World Bank, without language restrictions. Independent authors reviewed and selected abstracts based on set criteria. Data from included studies was extracted and analyzed. An adapted Critical Appraisal Skills Programme checklist designed for cohort studies was used to assess the risk of bias. Results After screening 3960 articles for eligibility, 16 were included for final analysis. Course delivery methods included didactic modules, simulations, clinical mentorship, small group discussion, audits, assessments, and feedback. Knowledge acquisition was primarily assessed through pre/post-tests, clinical skills assessments, and selfassessment questionnaires. Twelve studies detailed course content, nine of which were based on the WHO Emergency Triage, Assessment and Treatment model, which is not specific to trauma. The other three studies involved locally developed pediatric trauma-focused training courses, including airway management, head trauma and cervical spine management, thoracic and abdominal trauma, orthopedic trauma, burn and wound management, and shock. Conclusion Despite being essential to decreasing pediatric trauma morbidity and mortality worldwide, educational programs in pediatric trauma are not a widespread reality in low-and-middle-income countries. The development of accessible and efficient pediatric trauma education programs is critical for improving pediatric trauma quality of care.

Paediatric trauma education in low- and middle-income countries: A systematic literature review

“…In a similar assessment of paediatric inclusion in trauma education in LMICs, Pinkham et al also found an absence of internationally recognized paediatric trauma training programmes. They identified eight distinct courses (Emergency Triage, Assessment and Treatment plus Admission (ETAT+), Adapted Emergency Triage, Assessment, and Treatment (ETAT), Adapted Primary Trauma Care Course, Core Topics in Pediatric Emergency Care, Bastion Trauma Course, Pediatric Fundamental Critical Care Support, and two institutional paediatric trauma courses) [ 24 ]. All courses identified by Pinkham et al were different from those found by this review, highlighting the variability in existing educational options.…”

“…Pinkham et al’s [ 24 ] courses were assessed based on training modality, assessment methods, and outcomes. To assess the effectiveness of the identified courses, they used the Kirkpatrick’s Framework for Trauma Courses.…”

“…LMICs have a median age of 26.4 years compared to 41.5 years in high income countries [ 23 ]. Previous reviews have demonstrated this paucity of paediatric-specific trauma trainings in LMICs [ 24 ], but little is known about paediatric content in general trauma training. Given that paediatric injuries have a preventable death rate of nearly 32%, there needs to be a greater assessment of existing trauma curricula in order to optimize paediatric care [ 25 ].…”

A debriefing tool to acquire non-technical skills in trauma courses

“…Educational programs in trauma require hybrid educational approaches, including formal classroom techniques and simulation in immersive and realistic environments [ 1 ]. Moreover, training is required in both technical and non-technical skills [ 2 ], followed by a “hot debriefing” for knowledge and skills integration [ 1 ].…”