P3.085: Enhancing Emergency Medicine Trainees' Preparedness in Child Neurology Emergencies in India

Background: India has one of the largest pediatric populations globally with over 400 million children, where one in five pediatric patients has a neurological condition. However, access to specialized pediatric neurology care is limited due to a shortage of trained pediatric neurologists. Emergency medicine (EM) physicians, adult neurologists, or pediatricians manage most pediatric neurology cases. Strengthening the training and proficiency of EM physicians in managing neurological emergencies is imperative. This can be accomplished through simulation-based education, which serves as a platform to enhance knowledge, skills, and self-efficacy. This study aims to advance pediatric simulation-based education for EM trainees in India, focusing on improving the recognition and management of pediatric neurological emergencies.

Methods: The Ronald Reagan Institute of Emergency Medicine at George Washington University has partner programs across India to deliver postgraduate EM training programs. The study was conducted over two weeks in October 2024 and was facilitated by three visiting faculty members specializing in pediatric EM and EM, one pediatric neurology resident, and local EM faculty support. Training included a didactic session on pediatric neurological emergencies, a procedural workshop, and pediatric neurology emergency simulation cases. The structured procedural workshops used pre-existing checklists to achieve mastery learning in pediatric skills: intravenous access, intraosseous access (IO), bag-valve-mask ventilation, intubation, and lumbar puncture (LP). Simulation materials varied from site to site and cost effective solutions were pursued to simulate these procedures, including modifying plastic skeleton spines in Styrofoam containers for LP practice and thawed chicken legs for IO access. Trainees also completed three pediatric neurology simulation clinical cases. Pre- and post-surveys were used to evaluate the effectiveness of the educational intervention.

Results: 147 participants completed a pre-survey, 137 participants completed a post-survey, and 23 participants completed a three month post survey. A total of 106 EM trainees had matched results pre- and post- intervention for data analysis. Of the five procedural skills included in the study, participants had the least amount of experience with IO and LP. All domains assessed for the intervention showed significant pre- to post-test increases: medical knowledge (p = 0.01), procedural skills self efficacy (p < 0.001), and pediatric neurological emergency management self efficacy (p = 0.01). Self efficacy for procedural skills (p = 0.01) and pediatric neurological emergency management (p = 0.03) increased from pre-test to follow up with no respective significant differences between posttest and follow up (p = 0.06, p = 0.18) (Figure 2).

Conclusion: Simulation-based education significantly improves self-efficacy in pediatric neurological emergencies, procedural skills, and knowledge retention. This educational model can be replicated in other low-and-middle-income countries to improve pediatric emergency and subspecialized care globally. This study also suggests that innovative, cost-effective models may enhance procedural training in such resource-variable settings.