Our goal is to provide well rounded simulation curriculum that integrates with current developing systems-based curriculum that includes local bedside teaching, virtual lectures (weekly), POCUS lectures every 4-6 weeks. The current PCCM fellow simulation curriculum, PEM fellow simulation curriculum (CMH and Children’s National) will provide a starting point for content. The scenarios will need to be adapted to the local environment and needs. The curriculum is envisioned as a 2-pronged approach with the use of virtual simulation sessions and in person simulation sessions. Our goal in going to St. Paul's hospital is to educate the local fellows and attendings in simulation education, and help initiate an in-situ simulation program. Through this we will implement an education code cart and provide training to the PECCM fellows, residents, bedside staff and any others interested in participating in simulation training.
Currently, 80% of global pediatric mortality and 95% of pediatric injury-related deaths occur in low-middle income countries (LMICs). Most in-hospital deaths occur within the first 24 hours of admission. Dedicated training in Pediatric Emergency and Critical Care (PECC) is limited in LMICs despite high burden of illnesses. In Ethiopia, 50% of the population less than 15 years old (58 million), with 80% of deaths occur in children <5 years old. The evolving healthcare system (e.g., oncology, cardiac) necessitates well-trained PECC specialists. Currently, there are only three physicians in Ethiopia are PECC fellowship trained. A needs assessment has been completed through discussion with international health professionals, local administrators, interviews with parents/caregivers of children, and a literature review. The process was approved by the local senate to support the training of PECC fellows.
This educational model will impact the training of the local fellows, who will ultimate impact hundreds of children's lives in Ethiopia. Our goal is to create a program that is sustainable by the local experts to allow for ongoing growth and training for the up and coming trainees in PECC medicine.
Our primary goals during our trip to St. Paul's Hospital in Addis Ababa, Ethiopia were 2 fold. First we did an evaluation of the current pediatric code cart process, this allowed for us to re-create an education code cart to be utilized for future training. During this process we started with a needs assessment and plan to continue to improve upon their current pediatric code cart process, while continuing to update their educational code cart. We also introduced the concept of utilization of an educational code cart for simulation purposes to the staff. This was well received by the staff and their leadership. Through this we identified that perhaps the current process is not effective and there is a general desire to standardized the process across the Pediatric Intensive Care Unit and Pediatric Emergency Department. This of course will take time to accomplish, but we were able to obtain baseline data through pre/post surveys and will be able to utilized the information to provide evidence for the need of an updated process.
Additionally, we aimed to provide foundational educational framework for the team at St. Paul's hospital to develop and maintain their own In-situ simulation process. We were able to provide some educational framework, however, due to limited time we were unable to complete the entire curriculum, the remainder will be completed virtually. We were however, able to whiteness bedside rounds in the PICU, provide lectures to fellows and residents and complete 4 simulation sessions for the pediatric emergency critical care fellows. Through debriefing we identified that the PECC fellows are very interested in ongoing simulation sessions and would like to have more in person sessions. We will continue to work on our virtual simulation process, and do have a team planned to provide additional simulation sessions in the spring.
Ultimately our goal is to provide a sustainable In-Situ simulation program for the PECC fellows, and through this process there will be an improvement of the current pediatric code cart process. In order to have a successful In-situ program it is necessary to have the appropriate equipment that represents the equipment that is used during clinical care to train with. Hence the need for an educational code cart, and the need for ongoing assessment of its current effectiveness.
