RCEM Grant Number: LICG/2021/2

Ankur Verma, Shweta Gidwani, Tania Ahluwalia, Philippa Nicklin, Sanjay Jaiswal, Katherine Douglass

Abstract

Background - Unintentional injuries account for 810,000 deaths/year in children 18 years and younger globally, making it one of the top three causes of death in the 5-18 year age group. This burden falls disproportionately on low and middle income countries (LMICs) with more than 95% of these deaths occurring in these countries. Existing trauma courses, such as the Advanced Trauma Life Support (ATLS), have improved patient outcomes in some settings but have yet to be delivered at low cost and scale. The COVID-19 pandemic led to more use of online platforms for medical education and training; however, many platforms lack culturally and contextually relevant training materials. During the pandemic, we trialed and evaluated the use of tele-simulation to bring facilitators and learners from multiple geographical regions together to practice team-based emergency care. Online capacity-building partnerships have significant advantages: they are less expensive, more inclusive, and have the potential to scale up rapidly. We aimed to create a culturally and contextually relevant paediatric trauma tele-simulation to improve knowledge and confidence among emergency care providers in India.

Method – Real-life patient stories were collected from emergency medicine consultants to create a contextually relevant pediatric trauma case. The content, knowledge, and competency levels were based on established standards of care from WHO-BEC and ATLS. Volunteer emergency medicine residents developed and read the script. The scenario was played out by the residents and recorded. Short video clips interjected with discussion prompts were created, such as “How would you organize your team.” Indian hospital sites were invited to participate in the pilot sessions. The facilitator led the sessions and debriefed the participants. Feedback was collected regarding the effectiveness of the simulation and calculated on a Likert scale from  0-5.

Results – A total of 38 trainees from five centers in New Delhi, Kochi, and Thiruvilla participated in the pilot sessions, with a feedback response rate of 89.5% (34 out of 38 trainees). On a scale from 0 to 5, the average feedback scores were 4.88 for the relevance of the simulation to their work, 4.41 for the realism of the case, 4.64 for the effectiveness in teaching basic resuscitation skills, 4.41 for the effectiveness in teaching paediatric trauma management skills, and 4.50 for promoting reflection and team discussion during the debrief. These results indicate that the trainees found the tele-simulation training highly relevant, realistic, and effective in teaching basic resuscitation and paediatric trauma management skills, while the debrief sessions successfully promoted reflection and team discussion, further enhancing the learning experience.

Conclusion—We found the tele-simulation training to be positive, boost the trainees' confidence, and effective, as per the feedback provided. This is a potential tool that can be used to widen training reach across the country and region. This can serve as a sustainable and scalable model for paedatric trauma training in LMICs, potentially transforming emergency care education on a broader scale.

Presented at the Royal College of Emergency Medicine Annual Scientific Conference, September 2023

Watch the tele-simulation training