A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings.

Ye Myint Kyaw,Thazin Mon,Julie Rice,Nicole Shilkofski,Sarah Kiguli,Julianna Jung,Leslie Cope,Amanda Crichlow

doi:10.3389/fped.2018.00037

Abstract

Under five mortality rates (UFMR) remain high for children in low- and middle-income countries (LMICs) in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities). In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO) has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal. The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation. Infectious diseases (respiratory illnesses and diarrheal disease) were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations. Epidemiology of disease burden reported by respondents was relatively consistent with WHO country-specific UFMR statistics in each setting. Results of the needs assessment survey were subsequently used to refine goals and objectives for the simulation curriculum and to ensure delivery of pragmatic educational content with recommendations that were contextualized for local capacity and resource availability. Effective use of the tool in two different settings increases its potential generalizability.

Highlights

5.6 million children under the age of 5 years died in 2016 [1]
In applying our results from the needs assessment to refine the curriculum, we took into account a prior systematic review of resuscitation training in developing countries, which demonstrated that important educational outcomes are inconsistently defined and that training courses are often modified to available training resources, rather than to the needs and resources of
The implementation of the tool in two different countries in Asia and Africa helps to improve its generalizability for lowand middle-income countries (LMICs) settings in the developing world

Summary

Introduction

Since 1990, early childhood mortality has decreased substantially around the world, from 98 to 41 of every 1,000 live births. This rate remains much higher than the United Nations Sustainable Development Goal target of 25/1,000, and significant progress is needed to achieve this objective [2, 3]. One thing that has not changed among these factors is the lack of high quality and contextually appropriate educational curricula to teach provision of care to critically ill children in these settings. The World Health Organization (WHO) has developed the integrated management of childhood illness (IMCI) strategy and the emergency triage assessment and treatment (ETAT) guidelines for use in resource-limited settings [5, 6]. Provider education has been shown to improve quality of care, but even among trained providers, performance remains suboptimal, suggesting the need for additional educational reinforcement [10]

Methods

Results

Discussion

Conclusion