PDF(Pubmed)
Abstract：
Pediatric residents are increasingly pursuing global health electives. Differences in cultural norms and management around pediatric deaths in resource-limited settings can be emotionally overwhelming for residents. Educational resources are needed to better equip them for handling these stressful situations. We developed a predeparture simulation child death case to prepare pediatric residents for their global health elective.
The simulation module included a clinical case followed by a multidisciplinary structured debriefing. The case featured a 5-year-old, malnourished child in hypovolemic shock who clinically deteriorates and dies. After obtaining a history and performing a physical examination, residents were expected to diagnose severe malnutrition, treat hypovolemic shock, and decide how far to extend resuscitation with the limited resources. Upon returning from abroad, residents were invited to complete a survey on the utility of the simulation case module in preparing for their elective.
Twenty-nine residents participated in the simulation case module, and 18 completed the survey. Seventeen agreed or strongly agreed that the simulation module was a useful tool for preparation (Mdn = 4.5 on a 5-point Likert scale). Residents reflected that the simulation module helped manage expectations and provided them with an understanding of the cross-cultural differences in managing pediatric deaths in a resource-limited setting.
Pediatric residents trained in resource-rich countries do not encounter death often. Postgraduate training programs could consider simulations like this one to prepare such residents for cross-cultural differences in managing pediatric deaths and build resiliency to operate in resource-limited settings.
The simulation module included a clinical case followed by a multidisciplinary structured debriefing. The case featured a 5-year-old, malnourished child in hypovolemic shock who clinically deteriorates and dies. After obtaining a history and performing a physical examination, residents were expected to diagnose severe malnutrition, treat hypovolemic shock, and decide how far to extend resuscitation with the limited resources. Upon returning from abroad, residents were invited to complete a survey on the utility of the simulation case module in preparing for their elective.
Twenty-nine residents participated in the simulation case module, and 18 completed the survey. Seventeen agreed or strongly agreed that the simulation module was a useful tool for preparation (Mdn = 4.5 on a 5-point Likert scale). Residents reflected that the simulation module helped manage expectations and provided them with an understanding of the cross-cultural differences in managing pediatric deaths in a resource-limited setting.
Pediatric residents trained in resource-rich countries do not encounter death often. Postgraduate training programs could consider simulations like this one to prepare such residents for cross-cultural differences in managing pediatric deaths and build resiliency to operate in resource-limited settings.
摘要：
■儿科居民越来越多地追求全球健康选修课。在资源有限的环境中，围绕儿科死亡的文化规范和管理差异对居民来说可能是情感上的压倒。需要教育资源来更好地装备他们来处理这些紧张的情况。我们开发了离境前模拟儿童死亡病例，为儿科居民的全球健康选修课做好准备。
■模拟模块包括一个临床病例，然后进行多学科结构化的汇报。这个案子是一个5岁的孩子，营养不良儿童低血容量休克，临床恶化并死亡。在获得病史并进行身体检查后，预计居民会诊断出严重的营养不良，治疗低血容量性休克，并决定用有限的资源延长复苏的时间。从国外回来后,居民被邀请完成一项关于模拟案例模块在准备选修课程时的效用的调查。
■29名居民参加了模拟案例模块，18人完成了调查。17人同意或强烈同意模拟模块是有用的准备工具（在5点Likert量表上，Mdn=4.5）。居民反映，模拟模块有助于管理期望，并为他们提供了在资源有限的环境中管理儿科死亡的跨文化差异的理解。
■在资源丰富的国家接受培训的儿科住院医师不会经常遇到死亡。研究生培训计划可以考虑这样的模拟，以使这些居民为管理儿科死亡的跨文化差异做好准备，并建立在资源有限的环境中运作的弹性。
■模拟模块包括一个临床病例，然后进行多学科结构化的汇报。这个案子是一个5岁的孩子，营养不良儿童低血容量休克，临床恶化并死亡。在获得病史并进行身体检查后，预计居民会诊断出严重的营养不良，治疗低血容量性休克，并决定用有限的资源延长复苏的时间。从国外回来后,居民被邀请完成一项关于模拟案例模块在准备选修课程时的效用的调查。
■29名居民参加了模拟案例模块，18人完成了调查。17人同意或强烈同意模拟模块是有用的准备工具（在5点Likert量表上，Mdn=4.5）。居民反映，模拟模块有助于管理期望，并为他们提供了在资源有限的环境中管理儿科死亡的跨文化差异的理解。
■在资源丰富的国家接受培训的儿科住院医师不会经常遇到死亡。研究生培训计划可以考虑这样的模拟，以使这些居民为管理儿科死亡的跨文化差异做好准备，并建立在资源有限的环境中运作的弹性。
