Developing a pediatric emergency medicine simulation-based learning curriculum in Nepal

Pediatric Emergency Medicine (PEM) remains underdeveloped in low- and middle- income countries, such as Nepal. Among other limitations, there is a paucity of certification programs, such as Pediatric Advanced Life Support (PALS), and pediatric specific education curricula available to local providers. Low-fidelity simulation is an effective educational tool to improve providers' comfort with skills specific to the care of critically ill children. Our objectives were twofold. Firstly, to certify a pilot group of providers in PALS. Secondly, using the Kern's Model of Curriculum Development, we designed, implemented, and evaluated a contextualized simulation-based curriculum for preparing medical providers at Dhulikhel Hospital, an independent, not-for-profit academic hospital in Nepal, with the necessary skills to approach common pediatric emergencies.

Medical professionals who care for pediatric patients at Dhulikhel Hospital were included in our PALS and simulation-based training. Simulation cases were based on local needs assessment of the common pediatric emergency conditions, which included four scenarios: respiratory distress, status epilepticus, precipitous preterm delivery, and organophosphate poisoning. Participants completed anonymous pre- and post-simulation surveys regarding their comfort level with performing specific procedures and managing scenarios. Standardized pre-and-debriefing discussions were held. Key procedures were practiced after the simulations using hands-on skills stations. A 3-month post-course survey was conducted to assess retention of confidence.

Thirty-seven providers participated in the course. 54% (n = 20) had never participated in simulation prior. All questions showed a statistically significant difference in provider comfort. Provider comfort increased after implementation of low-fidelity simulation-based learning, with an emphasis on specific procedure training. A smaller difference was seen in tasks in which providers were already familiar, such as obtaining a history. The questions with the greatest difference in provider comfort directly corresponded to topics involving a skills station. The 3-month post-course survey demonstrated overall consistency with maintained comfort levels.

Low-fidelity simulation is effective and should be implemented in low- and middle- income countries, specifically with high acuity but lower occurrence skills, like intraosseous and umbilical line placement. As specialized PEM training expands, dedicated pediatric training courses and simulation-based learning can improve provider comfort with fundamental procedures to improve the outcomes of pediatric patients.