Feasible and effective use of a simulation-based curriculum for post-graduate emergency medicine trainees in India to improve learner self-efficacy, knowledge, and skills

Abstract

Background: Pediatric emergency medicine training is in its infancy in India. Simulation provides an educational avenue to equip trainees with the skills to improve pediatric care. We hypothesized that a simulation-based curriculum can improve Indian post-graduate emergency medicine (EM) trainees’ self-efficacy, knowledge, and skills in pediatric care. Methods: We designed a simulation-based curriculum for management of common pediatric emergencies including sepsis, trauma, and respiratory illness and pediatric-specific procedures including vascular access and airway skills. Training included didactics, procedural skill stations, and simulation. Measures included a self-efficacy survey, knowledge test, skills checklist, and follow-up survey. Results were analyzed using the Wilcoxon signed-rank test and paired-samples t test. A 6-month follow-up survey was done to evaluate lasting effects of the intervention. Results: Seventy residents from four academic hospitals in India participated. Trainees reported feeling significantly more confident, after training, in performing procedures, and managing pediatric emergencies (p < 0.001). After the simulation-based curriculum, trainees demonstrated an increase in medical knowledge of 19% (p < 0.01) and improvement in procedural skills from baseline to mastery of 18%, 20%, 16%, and 19% for intubation, bag-valve mask ventilation, intravenous access, and intraosseous access respectively (p < 0.01). At 6-month follow-up, self-efficacy in procedural skills and management of pediatric emergencies improved from baseline. Conclusions: A simulation-based curriculum is an effective and sustainable way to improve Indian post-graduate EM trainees’ self-efficacy, knowledge, and skills in pediatric emergency care.