(1111) Nepal: Where There Is No Pulmonologist-Building Neonatal-Pediatric Critical Care Ventilator Capacity

Introduction: Global Health environments lacking organic critical care capacity pose several challenges to building sustainable change. Logistically, it is very difficult for both the host nation and outside instructors to set aside the time and funding typically needed for initial and ongoing in-depth exclusively live training, be it in person or video based. Exclusively on-demand training mitigates these logistical barriers. However, from a cognitive neuroscience viewpoint, it fails to provide the components of clinical practice, mentorship, empowerment, and multidisciplinary teamwork essential for capacity building. Here, we discuss a hybrid low dose high frequency training model deployed in Nepal that successfully addressed these many challenges to build neonatal-pediatric pulmonology/respiratory therapy critical care capacity.

Methods: Over a period of several months, a nurse/physician led cohort of 20 Nepali neonatal and pediatric ICU nurses participated in weekly 90 minute video training sessions consisting of pre/post exams, a combination of interactive foundational theory including short answer problems, and student submitted morning/grand rounds style scenario based training. This encompassed blood gas interpretation, ventilator theory and application. Cases included surfactant deficiency, inhalation injury, asthma, etc.

Results: Empowering the students as active drivers of a psychologically safe dynamic low dose high frequency curriculum directly related to their clinical practice resulted in lasting subjective and objective improvements in both knowledge base and clinical application. 100% of the students showed 10-50+% improvement in pre/post testing and all reported and demonstrated increased confidence/competence in blood gas interpretation and ventilator adjustment as well as in teaching these skills. From a logistics point of view, all stakeholders agreed capacity was built with a negligible negative operational impact.

Conclusions: Our student driven low dose high frequency hybrid training model successfully addressed many challenges to build lasting multidisciplinary neonatal-pediatric pulmonology/respiratory therapy critical care capacity with minimal cost and disruption to day to day operations. These results may be translational in both global health and traditional training pipelines.