Lessons from the Design and Implementation of a Pediatric Critical Care and Emergency Medicine Training Program in a Low Resource Country - The South American Experience
The Fall 2017 IAMSE Web Seminar Series takes on an increased international flavor as presenters review health professions education around the world each with unique challenges and solutions. The goal of this series is to foster the exchange of ideas in the community of health science educators. Continuing with our longitudinal focus on competency-based-education, the series begins with an overview of medical education in Canada with an emphasis on the initiatives of the International Competencies in Basic Medical Education (ICBME). From the Far East, we will hear a presentation on Chinese medical education (World-China initiative) which places an emphasis on primary care in China. A panel will provide an overview of the European model of health professions education from globalization of education to global healthcare. Another presentation will explore medical education challenges and solutions in Sub-Saharan Africa. The series will conclude with a session focusing on an integrated model of medical care: childhood disease prevention in South America. At the end of the series the audience will be able to identify global challenges and solutions to medical education that may provide valuable perspectives at the local level.
For more than 60 years, the world has recognized the need for pediatric critical care (PCC). Today, most low- and middle-income countries (LMICs) still lack access to pediatric intensive care units (PICUs) and specialists, resulting in high rates of morbidity and mortality. These disparities result from several infrastructure and socioeconomic factors, chief among them is the lack of trained PCC and emergency medicine (PCCEM) frontline providers. In this seminar, we describe a continuing medical education model to increase frontline PCC capacity in Ecuador. The Laude in PCCEM is a program created by a team of Ecuadorian physicians at the University San Francisco de Quito School of Medicine. The program is aimed at providers with no formal training in PCC and who, nonetheless, care for critically ill children. The program resulted in stronger, more cohesive PICU teams with improved resuscitation times and coordination during simulation rounds. In hospitals that implemented the program, we saw decrease PICU mortality rates. Our aim is to identify the opportunities and challenges learned and to offer lessons for other countries that use similar models to cope with the lack of local resource availability.
Dean of School of Medicine, Universidad San Francisco de Quito, Ecuador
Dr. Grunauer is the Dean, the Director of Critical Care Areas, and a full-time professor at the Universidad San Francisco de Quito Medical School in Quito, Ecuador; the founder, Academic Director, and an attending of the Pediatric Intensive Care Unit of the Hospital de los Valles/Universidad San Francisco de Quito; and a Visiting Faculty Member at Johns Hopkins University. She is also the director of Ecuador’s Advanced Pediatric Life Support education program. Dr. Grunauer has dedicated thousands of hours to improving the quality of pediatric intensive and palliative care in Ecuador and other low resource settings through the development of continuing medical education, new models of care and PICU protocols, and innovative research studies to determine best-practices in these areas. She is a member of the highly prestigious Ecuadorian Academy of Medicine, a recipient of various local and international research grants, and the recipient of the 2016 Martha Bushore-Fallis APLS award for distinguished and innovative instructors of Advanced Pediatric Life Support. She is currently completing international research on pediatric palliative care practices, disaster relief, and palliative care education technology.
Highlights of the Webinar
Why do we prolong the survival of our critically ill patients?
- Children’s rights
- Health equity
- Social justice
The lower the number of beds, the higher the mortality rate!!
The Family-Centered Model of Care
- Shared decision-making model
- Multidisciplinary meetings that involve the family
- Consistency in communication and interculturality
- Presence of the family during rounds and CPR
- Flexible and constant visits
- Support for the family before, during and after the patient’s discharged or death.
Integrated Model of Care
- Critical Care + Palliative Medicine
- Pediatric Palliative Care (PPC)
- Pediatric palliative care prevents, identifies and treats the suffering of children with serious illnesses as well as that of their families and the teams that care for them.
Pediatric palliative care is appropriate in whatever stage of the disease, and it can be applied in conjunction with treatment directed at curing the disease.
Goal of the Study
- All children were admitted to the program (integrated model of care) regardless of their prognosis.
- To provide the best evidence-based, most cost-effective medicine focused on the conservation of resources in a socially responsible way.
How can the quality, sustainability and the impact be maintained?
- Combined the Advance Pediatric Life Support (APLS) with the integrated model of care.
This program resulted in stronger, more cohesive Pediatric Intensive Critical Unit (PICU) teams with improved resuscitation times and coordination during simulation rounds.
Hospitals that implemented the program had a decreased in mortality rates.
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- 1.00 CE Contact Hours