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West J Emerg Med. 2019 Dec 19;21(1):134-140. doi: 10.5811/westjem.2019.10.44534.

Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital.

The western journal of emergency medicine

Carol C Chen, Alexander L Werne, Katharine A Osborn, Holly Vo, Upendo George, Hendry Sawe, Newton Addo, Andrea T Cruz


  1. University of California, San Francisco, Section of Pediatric Emergency Medicine, Department of Emergency Medicine, San Francisco, California.
  2. University of California, San Francisco, Department of Pediatrics, San Francisco, California.
  3. University of Utah, Division of Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah.
  4. Muhimbili National Hospital, Department of Emergency Medicine, Dar Es Salaam, Tanzania.
  5. University of California, San Francisco, Department of Medicine, Clinical Pharmacology Program, San Francisco, California.
  6. University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.

PMID: 31913833 PMCID: PMC6948709 DOI: 10.5811/westjem.2019.10.44534


INTRODUCTION: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital.

METHODS: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations.

RESULTS: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group's results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions.

CONCLUSION: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.


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