Background: Pediatric Emergency Medicine (PEM) remains underdeveloped in low- and middle- income countries, such as Nepal. Among other limitations, there is a paucity of certification programs, such as Pediatric Advanced Life Support (PALS), and pediatric specific education curricula available to local providers. Low-fidelity simulation is an effective educational tool to improve providers' comfort with skills specific to the care of critically ill children. Our objectives were twofold. Firstly, to certify a pilot group of providers in PALS. Secondly, using the Kern's Model of Curriculum Development, we designed, implemented, and evaluated a contextualized simulation-based curriculum for preparing medical providers at Dhulikhel Hospital, an independent, not-for-profit academic hospital in Nepal, with the necessary skills to approach common pediatric emergencies.
Methods: Medical professionals who care for pediatric patients at Dhulikhel Hospital were included in our PALS and simulation-based training. Simulation cases were based on local needs assessment of the common pediatric emergency conditions, which included four scenarios: respiratory distress, status epilepticus, precipitous preterm delivery, and organophosphate poisoning. Participants completed anonymous pre- and post-simulation surveys regarding their comfort level with performing specific procedures and managing scenarios. Standardized pre-and-debriefing discussions were held. Key procedures were practiced after the simulations using hands-on skills stations. A 3-month post-course survey was conducted to assess retention of confidence.
Results: Thirty-seven providers participated in the course. 54% (n = 20) had never participated in simulation prior. All questions showed a statistically significant difference in provider comfort. Provider comfort increased after implementation of low-fidelity simulation-based learning, with an emphasis on specific procedure training. A smaller difference was seen in tasks in which providers were already familiar, such as obtaining a history. The questions with the greatest difference in provider comfort directly corresponded to topics involving a skills station. The 3-month post-course survey demonstrated overall consistency with maintained comfort levels.
Conclusion: Low-fidelity simulation is effective and should be implemented in low- and middle- income countries, specifically with high acuity but lower occurrence skills, like intraosseous and umbilical line placement. As specialized PEM training expands, dedicated pediatric training courses and simulation-based learning can improve provider comfort with fundamental procedures to improve the outcomes of pediatric patients.
Keywords: Global health; Nepal; PALS; Pediatric emergency medicine; Simulation-based learning.
© 2025. The Author(s).