Pediatric Resuscitation Education in Low-Middle-Income Countries: Effective Strategies for Successful Program Development

Abstract

Despite established international guidelines, there is considerable variability in the quality of resuscitative care received by critically ill children in low-middle-income countries. While this problem is certainly multifactorial, education of health care workers is an important determinant of care quality. This article will discuss approaches to health care worker education in pediatric resuscitation in low-middle-income countries, with emphasis on aspects of educational programs that may contribute to positive educational and clinical outcomes.

Keywords

education - resuscitation - low-middle-income country - simulation

• References

• 1 Liu L, Oza S, Hogan D. , et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385 (9966): 430-440
• 2 World Health Organization. Integrated Management of Childhood Illness Chart Booklet. Geneva, Switzerland: WHO Press; 2014
• 3 Kelly JM, Osamba B, Garg RM. , et al. Community health worker performance in the management of multiple childhood illnesses: Siaya District, Kenya, 1997-2001. Am J Public Health 2001; 91 (10) 1617-1624
• 4 Rowe AK, Onikpo F, Lama M, Cokou F, Deming MS. Management of childhood illness at health facilities in Benin: problems and their causes. Am J Public Health 2001; 91 (10) 1625-1635
• 5 Nguyen DT, Leung KK, McIntyre L, Ghali WA, Sauve R. Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS ONE 2013; 8 (06) e66030 . Doi: 10.1371/journal.pone.0066030
• 6 Meaney PA, Topjian AA, Chandler HK. , et al. Resuscitation training in developing countries: a systematic review. Resuscitation 2010; 81 (11) 1462-1472
• 7 Wayne DB, Butter J, Siddall VJ. , et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med 2006; 21 (03) 251-256
• 8 Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 2008; 133 (01) 56-61
• 9 Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med 2009; 37 (10) 2697-2701
• 10 Draycott TJ, Crofts JF, Ash JP. , et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol 2008; 112 (01) 14-20
• 11 Zendejas B, Cook DA, Bingener J. , et al. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg 2011; 254 (03) 502-509 , discussion 509–511
• 12 Phipps MG, Lindquist DG, McConaughey E, O'Brien JA, Raker CA, Paglia MJ. Outcomes from a labor and delivery team training program with simulation component. Am J Obstet Gynecol 2012; 206 (01) 3-9
• 13 Ersdal HL, Vossius C, Bayo E. , et al. A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates. Resuscitation 2013; 84 (10) 1422-1427
• 14 Msemo G, Massawe A, Mmbando D. , et al. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics 2013; 131 (02) e353-e360
• 15 Goudar SS, Somannavar MS, Clark R. , et al. Stillbirth and newborn mortality in India after helping babies breathe training. Pediatrics 2013; 131 (02) e344-e352
• 16 Carlo WA, Goudar SS, Jehan I. , et al; First Breath Study Group. Newborn-care training and perinatal mortality in developing countries. N Engl J Med 2010; 362 (07) 614-623
• 17 Kimura A, Okada K, Kobayashi K. , et al. Introductory adult cardiac life support course for Vietnamese healthcare workers. Resuscitation 2008; 79 (03) 511-512
• 18 Young S, Hutchinson A, Nguyen VT, Le TH, Nguyen DV, Vo TK. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam. Emerg Med Australas 2008; 20 (03) 271-275
• 19 Chung HS, Dieckmann P, Issenberg SB. It is time to consider cultural differences in debriefing. Simul Healthc 2013; 8 (03) 166-170
• 20 Steinert Y, Mann K, Centeno A. , et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach 2006; 28 (06) 497-526
• 21 Hallmark BF. Faculty development in simulation education. Nurs Clin North Am 2015; 50 (02) 389-397
• 22 McNeill J, Parker RA, Nadeau J, Pelayo LW, Cook J. Developing nurse educator competency in the pedagogy of simulation. J Nurs Educ 2012; 51 (12) 685-691
• 23 Xu T, Wang HS, Ye HM. , et al. Impact of a nationwide training program for neonatal resuscitation in China. Chin Med J (Engl) 2012; 125 (08) 1448-1456
• 24 Jayawardena A, Wijayasinghe SR, Tennakoon D, Cook T, Morcuende JA. Early effects of a “train the trainer” approach to Ponseti method dissemination: a case study of Sri Lanka. Iowa Orthop J 2013; 33: 153-160
• 25 Enweronu-Laryea C, Engmann C, Osafo A, Bose C. Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa. Resuscitation 2009; 80 (11) 1308-1311
• 26 Williams AB, Le ST, Colby D, Thu Le TT, Pollack T, Cosimi L. Effectiveness of train-the-trainer HIV education: a model from Vietnam. J Assoc Nurses AIDS Care 2014; 25 (04) 341-350
• 27 Rajapakse BN, Neeman T, Dawson AH. The effectiveness of a “train the trainer” model of resuscitation education for rural peripheral hospital doctors in Sri Lanka. PLoS ONE 2013; 8 (11) e79491 . Doi: 10.1371/journal.pone.0079491
• 28 Carlo WA, McClure EM, Chomba E. , et al. Newborn care training of midwives and neonatal and perinatal mortality rates in a developing country. Pediatrics 2010; 126 (05) e1064-e1071
• 29 Nelissen E, Ersdal H, Ostergaard D. , et al. Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting. Acta Obstet Gynecol Scand 2014; 93 (03) 287-295
• 30 Meaney PA, Sutton RM, Tsima B. , et al. Training hospital providers in basic CPR skills in Botswana: acquisition, retention and impact of novel training techniques. Resuscitation 2012; 83 (12) 1484-1490
• 31 Brydges R, Nair P, Ma I, Shanks D, Hatala R. Directed self-regulated learning versus instructor-regulated learning in simulation training. Med Educ 2012; 46 (07) 648-656
• 32 Hernández-Padilla JM, Suthers F, Granero-Molina J, Fernández-Sola C. Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: a cluster randomised trial. Resuscitation 2015; 93: 27-34
• 33 Weiner GM, Menghini K, Zaichkin J, Caid AE, Jacoby CJ, Simon WM. Self-directed versus traditional classroom training for neonatal resuscitation. Pediatrics 2011; 127 (04) 713-719
• 34 Mikrogianakis A, Kam A, Silver S. , et al. Telesimulation: an innovative and effective tool for teaching novel intraosseous insertion techniques in developing countries. Acad Emerg Med 2011; 18 (04) 420-427
• 35 Okrainec A, Henao O, Azzie G. Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries. Surg Endosc 2010; 24 (02) 417-422
• 36 Brisson AM, Steinmetz P, Oleskevich S, Lewis J, Reid A. A comparison of telemedicine teaching to in-person teaching for the acquisition of an ultrasound skill - a pilot project. J Telemed Telecare 2015; 21 (04) 235-239
• 37 Ali J, Sorvari A, Camera S, Kinach M, Mohammed S, Pandya A. Telemedicine as a potential medium for teaching the advanced trauma life support (ATLS) course. J Surg Educ 2013; 70 (02) 258-264
• 38 Jain A, Agarwal R, Chawla D, Paul V, Deorari A. Tele-education vs classroom training of neonatal resuscitation: a randomized trial. J Perinatol 2010; 30 (12) 773-779
• 39 Norman G, Dore K, Grierson L. The minimal relationship between simulation fidelity and transfer of learning. Med Educ 2012; 46 (07) 636-647
• 40 Adams AJ, Wasson EA, Admire JR. , et al. A comparison of teaching modalities and fidelity of simulation levels in teaching resuscitation scenarios. J Surg Educ 2015; 72 (05) 778-785
• 41 Curran V, Fleet L, White S. , et al. A randomized controlled study of manikin simulator fidelity on neonatal resuscitation program learning outcomes. Adv Health Sci Educ Theory Pract 2015; 20 (01) 205-218
• 42 Perosky J, Richter R, Rybak O. , et al. A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa. Simul Healthc 2011; 6 (01) 42-47
• 43 Walker DM, Cohen SR, Estrada F. , et al. PRONTO training for obstetric and neonatal emergencies in Mexico. Int J Gynaecol Obstet 2012; 116 (02) 128-133
• 44 Taché S, Mbembati N, Marshall N, Tendick F, Mkony C, O'Sullivan P. Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania. Hum Resour Health 2009; 7: 64 . Doi: 10.1186/1478-4491-7-64
• 45 Washington CH, Tyler FJ, Davis J. , et al. Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar. Int J Emerg Med 2014; 7 (01) 46 . Doi: 10.1186/s12245-014-0046-z
• 46 Kigozi G, Nkale J, Wawer M. , et al. Designing and usage of a low-cost penile model for male medical circumcision skills training in Rakai, Uganda. Urology 2011; 77 (06) 1495-1497
• 47 Waikakul S, Vanadurongwan B, Chumtup W, Assawamongkolgul A, Chotivichit A, Rojanawanich V. A knee model for arthrocentesis simulation. J Med Assoc Thai 2003; 86 (03) 282-287
• 48 World Health Organization. Global Initiative for Emergency and Essential Surgical Care. World Health Organization. http://www.who.int/surgery/publications/s15986e.pdf?ua=1 . Accessed July 21, 2015
• 49 Vukoja M, Riviello E, Gavrilovic S. , et al; CERTAIN Investigators. A survey on critical care resources and practices in low- and middle-income countries. Glob Heart 2014; 9 (03) 337-342.e1 , 5
• 50 Baker T, Lugazia E, Eriksen J, Mwafongo V, Irestedt L, Konrad D. Emergency and critical care services in Tanzania: a survey of ten hospitals. BMC Health Serv Res 2013; 13: 140 . Doi: 10.1186/1472-6963-13-140
• 51 Hsia RY, Mbembati NA, Macfarlane S, Kruk ME. Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. Health Policy Plan 2012; 27 (03) 234-244
• 52 Notrica MR, Evans FM, Knowlton LM, Kelly McQueen KA. Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 2011; 35 (08) 1770-1780
• 53 Chirdan LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA. Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 2010; 45 (03) 610-618
• 54 Ralston ME, Day LT, Slusher TM, Musa NL, Doss HS. Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 2013; 381 (9862): 256-265
• 55 World Health Organization. Emergency Triage Assessment and Treatment Course. World Health Organization. http://www.who.int/maternal_child_adolescent/documents/9241546875/en/ . Accessed July 21, 2015
• 56 Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 2006; 84 (04) 314-319
• 57 Maitland K, Kiguli S, Opoka RO. , et al; FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011; 364 (26) 2483-2495
• 58 Wright SW, Steenhoff AP, Elci O. , et al. Impact of contextualized pediatric resuscitation training on pediatric healthcare providers in Botswana. Resuscitation 2015; 88: 57-62
• 59 Mills DM, Wu CL, Williams DC, King L, Dobson JV. High-fidelity simulation enhances pediatric residents' retention, knowledge, procedural proficiency, group resuscitation performance, and experience in pediatric resuscitation. Hosp Pediatr 2013; 3 (03) 266-275
• 60 Chamberlain D, Smith A, Woollard M. , et al. Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training. Resuscitation 2002; 53 (02) 179-187
• 61 Sullivan N. An integrative review: instructional strategies to improve nurses' retention of cardiopulmonary resuscitation priorities. Int J Nurs Educ Scholarsh 2015; 12: 37-43
• 62 Lin Y, Cheng A. The role of simulation in teaching pediatric resuscitation: current perspectives. Adv Med Educ Pract 2015; 6: 239-248
• 63 Barry JS, Gibbs MD, Rosenberg AA. A delivery room-focused education and deliberate practice can improve pediatric resident resuscitation training. J Perinatol 2012; 32 (12) 920-926
• 64 Cordero L, Hart BJ, Hardin R, Mahan JD, Nankervis CA. Deliberate practice improves pediatric residents' skills and team behaviors during simulated neonatal resuscitation. Clin Pediatr (Phila) 2013; 52 (08) 747-752
• 65 Hunt EA, Duval-Arnould JM, Nelson-McMillan KL. , et al. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation 2014; 85 (07) 945-951
• 66 Oermann MH, Kardong-Edgren SE, Odom-Maryon T. Effects of monthly practice on nursing students' CPR psychomotor skill performance. Resuscitation 2011; 82 (04) 447-453
• 67 Sutton RM, Niles D, Meaney PA. , et al. “Booster” training: evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during simulated cardiac arrest. Pediatr Crit Care Med 2011; 12 (03) e116-e121
• 68 Sutton RM, Niles D, Meaney PA. , et al. Low-dose, high-frequency CPR training improves skill retention of in-hospital pediatric providers. Pediatrics 2011; 128 (01) e145-e151
• 69 Kurosawa H, Ikeyama T, Achuff P. , et al. A randomized, controlled trial of in situ pediatric advanced life support recertification (“pediatric advanced life support reconstructed”) compared with standard pediatric advanced life support recertification for ICU frontline providers*. Crit Care Med 2014; 42 (03) 610-618