(1099) A Simulation-Based Approach to Critical Care Training for Pediatricians in Low-Resource Settings

Introduction: In Nigeria, childhood mortality from critical illness is high due to absence of trained providers and lack of adequate healthcare resources. To bridge the knowledge and skills gap, we conducted a simulation-based training in pediatric critical at a University Teaching Hospital in Ibadan, Nigeria from Nov 7-10, 2023. The target audience are general pediatricians and pediatric subspecialists. The specific aim of the course is to improve provider skills to prevent rapid deterioration and enhance early recognition of critical illness. The training was funded through the auspices of the Zoll Foundation.

Methods: After a pretest 35 participants underwent 980 learner hours of simulated training with high fidelity portable simulator (REALITi 360, ISimulate, Albany, NY). and QCPR manikins (Laerdal ). Pediatric CPR training was conducted using BLS and PALS techniques; didactics include simulated-case based discussions and scenarios with organ-systems themes e.g. pediatric shock, cardio- respiratory failure. Debriefing with formative feedback was provided after each scenario. Deliberate practice of CPR skills for mastery learning and skills retention was conducted. knowledge transfer was assessed with posttest analysis. Team training sessions enhanced situational leadership, decision making and communication skills. Learners overall assessment of the simulation exercise was conducted using Kirkpatrick's method and self-efficacy surveys.

Results: Pre and post-test results of 35 participants was analyzed. Knowledge gain was determined using the difference between post and pre-test scores. Only 30 participants had complete data set for analysis.. Kolmogorov Smirnov's test on the score differences indicated a non-normal distribution. Pre- and post-test were compared using Wilcoxon Signed Rank test. There was a significant difference between pre and post -test scores (p=2.6e-6). We applied a significance level (α) of 0.05 for all statistical tests conducted in this study. All analysis was conducted using R 4.3.2.

Conclusions: In resource poor settings, pediatricians with no prior training in critical care can be effectively trained with simulation methods. Simulation is a potentially effective tool for bridging critical care knowledge and skills gap in Nigeria and other African countries.