West J Emerg Med. 2019 Dec 19;21(1):134-140. doi: 10.5811/westjem.2019.10.44534.
Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital.
The western journal of emergency medicine
Carol C Chen, Alexander L Werne, Katharine A Osborn, Holly Vo, Upendo George, Hendry Sawe, Newton Addo, Andrea T Cruz
- University of California, San Francisco, Section of Pediatric Emergency Medicine, Department of Emergency Medicine, San Francisco, California.
- University of California, San Francisco, Department of Pediatrics, San Francisco, California.
- University of Utah, Division of Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah.
- Muhimbili National Hospital, Department of Emergency Medicine, Dar Es Salaam, Tanzania.
- University of California, San Francisco, Department of Medicine, Clinical Pharmacology Program, San Francisco, California.
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.
PMCID: PMC6948709 DOI: 10.5811/westjem.2019.10.44534
INTRODUCTION: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital.
METHODS: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations.
RESULTS: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group's results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions.
CONCLUSION: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.
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