Implementation and evaluation of a simulation-based shock curriculum in the Philippines

ABSTRACT

INTRODUCTION: Children in low-middle income countries are disproportionately affected by shock, resulting in high mortality. Simulation has been successfully used as an educational tool in some low-resource settings. The objective of this study was to develop and evaluate educational efficacy of a simulation-based pediatric shock curriculum for pediatric residents in Manila, Philippines. We hypothesized that there would be decreased time to administration of first fluid bolus on a simulated mannequin after participation in the curriculum. METHODS: Prospective pre/post cohort study assessing a skills-based shock curriculum consisting of a multiple choice pre/post-test and a videotaped simulation-based pre/posttest. Implemented at Philippine Children's Medical Center in March 2020. Performance in simulation shock scenario was assessed by standardized checklist. Outcome measures were compared pre- and post intervention. Interrater and intrarater reliability on checklist assessed. RESULTS: Due to the COVID-19 pandemic, resident enrollment in the study was stopped prematurely. A total of 24 residents were enrolled. 96% of participants were female. Individuals reported a mean of 4/5 confidence in English in the medical setting (SD .66 CI 95% 3.7-4.3). Confidence in identifying shock (3.8 -> 4.3 p <0.01), identifying malnutrition (3.2 -> 4.1 p <0.01), managing hypovolemic shock (3.6 -> 4.3 p <0.01), managing septic shock (3.3 -> 4.1 p <0.01) and placing an IO (2.8 -> 4.0 p <0.01) all increased. Mean written test score showed no significant improvement (9.4/10 to 9.8/10, p = 0.15) but this may have been related to high pre-intervention performance on knowledge based test. The time to initiation of fluids did not change (83 s -> 75 s p = 0.42), although all residents initiated fluids within five minutes both pre and post-intervention. The total score on the checklist improved (9.8 -> 14.7, p <0.01). CONCLUSIONS: There was no difference in time to initiation of fluids pre/post intervention. There was improvement in confidence with shock concepts. Overall score on the checklist improved, which may be the most accurate marker of knowledge acquisition in this scenario. Through international collaboration it is possible to establish a successful simulation-based education program for trainee.