A Pediatric Emergency Medicine Refresher Course for Generalist Healthcare Providers in Belize: Respiratory Emergencies

Abstract

Audience and type of curriculum: This is a refresher curriculum utilizing multiple methods of education to augment 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. Length of curriculum: Nine hoursIntroduction: In the pediatric population, early recognition and stabilization can improve patient outcomes. Compared with many Western systems that rely on specialists and even subspecialists, in many lowerresource settings, generalists provide most emergency medical care. The purpose of this module is to present a curriculum focused on the identification and stabilization of common pediatric respiratory emergencies for general practitioners (physicians and nurses) working in the acute care setting. Our aim is to provide a care framework and refresher training for the management of pediatric respiratory emergencies for providers who may regularly see the acutely ill pediatric patient but who may not have had recent or any extensive teaching in the management of acute pediatric airway management, bronchiolitis, pneumonia, and asthma. CURRICULUM 74 Section breakEducational Goals: This curriculum presents a refresher course in recognizing and stabilizing pediatric acute respiratory complaints for generalist healthcare providers practicing in LMICs. Our goal is to implement this curriculum in the small LMIC of Belize. This module focuses on common respiratory complaints, including asthma, bronchiolitis, pneumonia and acute airway management. Educational Methods:The educational strategies used in this curriculum include didactic lectures, medical simulation, small-group sessions, and a skills lab.Research Methods: We scored written pretests before and posttests after intervention and retested participants to evaluate for knowledge retention. Participants provided qualitative feedback on the module. Results:We taught 26 providers. Twenty-one providers completed the posttest and eight completed the retest. The mean test scores improved from 8.3 ± 2.8 in the pretest to 9.7 ± 1.3 to the posttest (mean difference = 1.4; P = 0.027). The mean test score at pretest was 8.0 ± 4.0, which increased to 9.9 ± 2.5 at retest four months later (mean difference = 1.9, P = 0.049). Fifteen (71.4%) participants found the course "extremely useful," and 28 (28.5%) participants "very useful." Discussion: This curriculum is an effective and well-received training tool for Belizean generalist providers. Although limited by sample size and 20% attrition for the retest, there was a statistically significant improvement in test performance. We believe that our pilot in Belize shows that this type of refresher course could be useful for teaching generalist providers in LMICs to optimize care of the acutely ill pediatric patient with respiratory ailment. Evaluation of other modules in this curriculum, application of the curriculum in other locations, and measuring clinical ...

Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize

“…A total of 26 learners participated in educational programs offered. The participants included 14 physicians (11 of 16 practicing in the KHMHA ED) and 11 nurses (11 of 22 practicing in the KHMHA ED) 16 …”

“…The participants included 14 physicians (11 of 16 practicing in the KHMHA ED) and 11 nurses (11 of 22 practicing in the KHMHA ED). 16 A retrospective chart review was conducted in 2019 to assess the curriculum's clinical effectiveness, focusing on key process markers as a proxy for clinical impact (see Data Collection and Outcomes section).…”

“…Although located in Central America, Belize is also a Caribbean nation, included among the 20 members of the Caribbean Community. Most Belize physicians are medically trained outside the country and return to practice with a diverse wealth of knowledge applied to clinical care 2 . Most physicians in Belize qualify as general practitioners; few of the physician population are residency-trained in a specialty.…”

“…As such, generalists manage most acutely ill pediatric patients in emergency departments (ED), pediatric wards, intensive care units (ICUs), and clinics with limited access to pediatric specialists for consultation. Although physicians must complete continuing medical education to practice, there are limited in-country protocols, and practitioners tend to subscribe to various international protocols and algorithms 2 . Acute pediatric care is dependent on guidelines set by other countries and the World Health Organization, an individual's training and experiences, and local practice patterns.…”

“…We performed a needs assessment in 2016 of pediatric emergency care at Karl Heusner Memorial Hospital Authority (KHMHA). Our needs assessment identified pediatric respiratory complaints as an area of focus 2 . Respiratory complaints were the prevailing reason for pediatric patients presenting to KHMHA either as direct admissions, ED visits, or transfers.…”