A novel program to enhance pediatric emergency medicine training in Thailand.

Abstract

In Thailand, there are few pediatric emergency medicine (PEM) fellowship-trained providers, and emergency departments (EDs) are staffed by pediatricians and emergency physicians. Our pediatric ED collaborated with Thailand's largest private hospital system to develop a training program designed to improve emergency care for children. The objective was to develop, implement, and assess the efficacy of a curriculum to improve PEM care by emergency providers in a Thai health system. We conducted a prospective study from January 2018 to July 2019. After an initial needs assessment, we developed a curriculum with 22 modules, divided into basic and advanced courses. Each course began with baseline testing, consisting of written tests and several simulated cases led by physician-nurse teams. Each course was administered longitudinally through electronic modules over 6months, with in-person shadowing and skills workshops at the course midpoint, culminating in final summative examinations and repeat simulation testing. On written examination scores for the basic course, physicians (n=5) improved by 37.6% (95% confidence interval [CI]= 29.8% to 45.4%, p<0.001), while nurses (n=5) improved by 55.7% (95% CI= 45.8% to 65.6%, p<0.001). For simulation testing among physician-nurse dyads, performance improved by 19.5% (95% CI= 3.9% to 35.1%, p=0.004) for critical action items and by 3.0 points (95% CI= 2.3 to 3.7, p<0.001) on a 16-point teamwork scale. For the advanced course, physicians improved on the written examination by 36.9% (95% CI= 29.2% to 44.7%, p<0.001) and nurses by 50.6 (95% CI= 47.3% to 54.0%, p<0.001). For simulation testing, performance improved from 22.2% (95% CI= 8.2% to 35.6%, p<0.001) for critical actions and 1.3 points (95% CI= 0.2 to 2.2, p=0.005) on teamwork measures. We designed an interdisciplinary curriculum and successfully trained Thai physicians and nurses to improve PEM knowledge and teamwork.