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Development and Validation of a Simulation-Based Pediatric Anesthesia Training Program in Japan: The J-MEPA
Sachi Ishida1,2,3, Tomoe Sakurai1,4, Satoshi Ohashi1
1Department of Anesthesiology, Saitama Children's Medical Center, Saitama, Japan.
Insights
A new simulation program, Japanese version of Managing Emergencies in Pediatric Anesthesia (J-MEPA), was developed to address pediatric anesthesia training gaps in Japan. The program showed acceptable reliability and validity, with participants reporting increased confidence and motivation.
Area of Science:
- Anesthesiology
- Medical Education
- Simulation Training
Background:
- Pediatric anesthesia poses higher risks than adult anesthesia.
- Limited clinical exposure to pediatric cases in Japan due to demographic shifts.
- Lack of a validated pediatric anesthesia simulation program in Japan.
Purpose of the Study:
- To develop and implement a culturally adapted simulation-based training program for pediatric anesthesia in Japan.
- The program is named the Japanese version of Managing Emergencies in Pediatric Anesthesia (J-MEPA).
Main Methods:
- Phase 1: Translation, cultural adaptation, and feasibility testing of the English MEPA course.
- Phase 2: Implementation of J-MEPA, evaluating inter-rater reliability, criterion-related validity, and educational effectiveness.
- Performance assessment using video recordings, a revised checklist, and behaviorally anchored rating scale (BARS), with reliability assessed by intraclass correlation coefficients (ICC).
Main Results:
- Forty-four participants completed 209 simulations.
- Acceptable inter-rater reliability for both the revised checklist (ICCs 0.54–0.86) and BARS (ICCs 0.50–0.79).
- Positive correlation between BARS scores and pediatric experience, indicating preliminary validity; participants reported high satisfaction, engagement, and increased confidence.
Conclusions:
- The Japanese version of MEPA (J-MEPA) was successfully developed and preliminarily evaluated.
- Demonstrated acceptable reliability, initial criterion-related validity, and positive educational outcomes.
- J-MEPA provides a feasible, culturally appropriate solution for pediatric anesthesia training gaps in Japan, potentially serving as a model for other contexts.
Background:
Pediatric anesthesia carries a higher risk of complications than adult anesthesia, yet clinical exposure to pediatric cases is increasingly limited in Japan due to declining birth rates and urban-rural disparities. Although simulation-based education improves clinical competency, no validated program exists in Japan for pediatric anesthesia.
Aims:
This study aimed to develop and implement a culturally adapted, simulation-based training program for pediatric anesthesia in Japan, the Japanese version of Managing Emergencies in Pediatric Anesthesia (J-MEPA).
Methods:
This study was conducted in two phases. Phase 1 involved the translation, cultural adaptation, and feasibility testing of the original English MEPA course. Phase 2 implemented J-MEPA and evaluated inter-rater reliability, criterion-related validity, and educational effectiveness. All simulations were video-recorded; learners' performance was assessed by trained pediatric anesthesiologists using a revised checklist with added sub-items and behaviorally anchored rating scale (BARS). The reliability of these assessments was evaluated using intraclass correlation coefficients (ICC). Validity was examined by correlations between participants' clinical experience and performance scores. Educational effectiveness, focusing on reaction and learning, was measured using a post-course questionnaire with the Kirkpatrick Model.
Results:
Forty-four participants completed 209 simulations. Inter-rater reliability was acceptable across scenarios (ICCs ranging from 0.54 to 0.86 for the revised checklist; 0.50 to 0.79 for BARS). We explored criterion-related validity, and the positive correlation between BARS scores and pediatric experience was consistent with preliminary validity evidence, whereas the revised checklist scores were modest. Participants reported high satisfaction, engagement, relevance, and increased confidence and motivation to apply skills learned in the course.
Conclusions:
The Japanese version of MEPA was successfully developed and preliminarily evaluated. We observed acceptable inter-rater reliability, initial evidence of criterion-related validity, and positive educational outcomes. J-MEPA offers a feasible, culturally appropriate approach to addressing pediatric anesthesia training gaps in Japan and may serve as a model for adapting simulation-based training to similar healthcare contexts, while warranting further evaluation in larger and more diverse settings.
Trial Registration:
University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Japan Trial ID: UMIN000040879.
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