(677) Five Years on the Frontier: Building PCCM Capacity in Nepalese Critical Access Charity Hospitals

Introduction: Pediatric Critical Care Medicine (PCCM) as a subspecialty in Nepal is a rarity. There is little to no organic capacity to provide formal training in PCCM topics or the High-Performance Teamwork necessary for building successful Multidisciplinary PCCM Teams. Likewise, given the operational necessities of a critical access Resource Limited Environment (RLE), lengthy discrete nonnative training pipelines are impractical. We successfully deployed a validated culturally sensitive and student-centered modular curriculum utilizing High Yield Pedagogy to promote a reproducible rapid upscaling of multidisciplinary PCCM team capacity at three major surgical facilities in Nepal.

Methods: Our High Yield Pedagogy approach overcomes operational time constraints and builds PCCM capacity by using a step-wise micro-modular approach to a broad PCCM curriculum by hybridizing short missions on the ground with regular tele-teaching sessions in between. It emphasizes PCCM Capacity building from the outset and stresses Psychological Safety, Scenario Based Training, and 360 Degree Feedback to optimize rapid knowledge acquisition and translation into clinical practice as a cohesive High Performance PCCM Team. In all curriculums, capacity building and self-sufficiency were emphasized and to that end, all students were trained and evaluated as individuals, team leaders, and instructors.

Results: Over 5 years, in each of our three charity centers, Kirtipur, Chitwan, and Pokhara, a combined total of 100+ MD and RN students were trained and passed successful evaluation as PCCM Team Leaders and Instructors across a wide variety of Medical, Surgical, and Trauma skillsets and scenarios. This training is ongoing and open ended. Additionally, through the donation of mannikins, simulation software, and equipment, they have been able to independently conduct numerous PCCM workshops and have reported consistently improved didactic and clinical outcomes

Conclusions: High Yield Pedagogy is an effective methodology to promote sustainable High Performance PCCM Teams and optimize complex clinical outcomes under time constrained operating conditions in Low Middle Income Countries. Our Micro-Modular Model is not only applicable in humanitarian settings, but also arguably equally so in any didactic or clinical academic context.