A Simulation and Small-Group Pediatric Emergency Medicine Course for Generalist Healthcare Providers: Gastrointestinal and Nutrition Emergencies.

Abstract

Audience and type of curriculum: This is a review curriculum utilizing multiple methods of education to enhance the skills of generalist healthcare providers in low- and middle-income countries (LMICs) in the identification and stabilization of pediatric respiratory emergencies. Our audience of implementation was Belizean generalist providers (nurses and physicians).

Length of curriculum: 8-10 hours.

Introduction: Early recognition and stabilization of critical pediatric patients can improve outcomes. Compared with resource-rich systems, many low-resource settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. We created a curriculum for general practitioners comprising multiple educational modules focused on identifying and stabilizing pediatric emergencies. Our aim was to develop an educational framework to update and teach generalists on the recommendations and techniques of optimally evaluating and managing pediatric nutritional and gastrointestinal emergencies: bowel obstructions, gastroenteritis, and malnutrition.

Educational goals: The aim of this curriculum is to increase learners' proficiency in identifying and stabilizing acutely ill pediatric patients with gastrointestinal medical or surgical disease or complications of malnutrition. This module focuses on the diagnosis and management of gastroenteritis, acute bowel obstruction, and deficiencies of feeding and nutrition. The target audience for this curriculum is generalist physicians and nurses in limited-resource settings.

Educational methods: The educational strategies used in this curriculum include didactic lectures, medical simulation, and small-group sessions.

Research methods: We evaluated written pretests before and posttests after intervention and retested participants four months later to evaluate for knowledge retention. Participants provided qualitative feedback on the module.

Results: We taught 21 providers. Eleven providers completed the pretest/posttest and eight completed the retest. The mean test scores improved from 8.3 ± 1.7 in the pretest to 12.2 ± 2.6 in the posttest (mean difference: 1.4, P=0.027). The mean test score at pretest was 8.3 ± 2.3, which increased to 10.8 ± 3.0 at retest (mean difference: 2.5, P=0.060). Seven (71.4%) and four (28.5%) participants found the course "extremely useful" and "very useful," respectively (n=11).

Discussion: This curriculum may be an effective and welcome training tool for Belizean generalist providers. There was a statistically significant improvement in the test performance but not in retesting, possibly due to our small sample size and high attrition rate. Evaluation of other modules in this curriculum, application of this curriculum in other locations, and measuring clinical practice interventions will be included in future investigations.

Topics: Medical simulation, rapid cycle deliberate practice (RCDP), Belize, gastrointestinal, nutrition, emergency, gastroenteritis, acute bowel obstruction, Belize, low- and middle-income country (LMIC), collaboration, global health.