Introduction: Simulation-based education is increasingly recognized as a tool to improve patient safety in critical care. In low-resource pediatric intensive care settings, in situ simulation can identify latent safety threats (LSTs) and enhance team preparedness. We hypothesized that structured simulation training would improve knowledge, teamwork, and system awareness while identifying key LSTs. This project is part of my International Pediatric Simulation Society (IPSS-INSPIRE) Fellowship. Methods: This mixed-methods study involved 90 participants—emergency physicians, pediatric residents, critical care fellows, and nurses—enrolled in three structured simulation-based training sessions. There were three scenarios: 1. Traumatic brain inury.2. Resuscitation. 3. Septic Shock.Each session included a pre- and post-test to assess knowledge and structured debriefings using PEARLS and SAFEE frameworks. SEIPS 2.0 Framework was applied to understand human frameworks. A qualitative content analysis of 90 debriefing transcripts was conducted using an inductive approach in NVivo 11.Follow-up interviews were conducted six weeks later with the same participant groups to assess retention and re-identification of LSTs. Results: Participants’ average knowledge scores improved from 68% pre-test to 89% post-test. All participants identified at least eight LSTs per session. Five major themes emerged: team coordination issues, role ambiguity, limited equipment availability, communication breakdowns, and system-level workflow problems. There was significant improvement in the identification of latent safety threats across all three clinical scenarios (p< 0.05). The mean threat identification score increased from 4.2 (SD = 1.1) to 7.8 (SD = 1.4), a gain of 86%. Scenario completion time improved by 1–2 minutes post-training. Participants reported improved confidence and implementation of structured team behaviors in their daily clinical practice. Effective communication was identified as the major LST. Conclusions: In situ simulation effectively identified latent safety threats and led to measurable improvements in knowledge, teamwork, and clinical confidence among pediatric critical care teams in a low-resource setting. Sustained simulation efforts may contribute to safer, more efficient systems and improved patient outcomes.
Ishaque et al. (Sun,) studied this question.