Development and implementation of a modified IMEGH Paediatric Advanced Life Support course in a low-resource setting

• Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. • The Initiative for Medical Equity and Global Health (IMEGH) developed context-informed modified resuscitation courses including a Paediatric Advanced Life Support (PALS) course for medical providers in low resourced settings. • This paper outlines the implementation of a modified IMEGH PALS course for medical providers in Botswana and reports on the educational outcomes of participants. The Initiative for Medical Equity and Global Health (IMEGH) Paediatric Advanced Life Support (PALS) course was developed for low-resource settings as a more applicable, affordable, and feasible alternative to the often cost-prohibitive and logistically difficult American Heart Association (AHA) course. The objective was to implement and assess the impact of a modified IMEGH PALS course on participants’ pre- and post-course paediatric resuscitation knowledge, self-confidence scores and simulation performance. This was a mixed-methods study of medical professionals who voluntarily enrolled in the IMEGH PALS Course at the 2024 African Conference of Emergency Medicine in Gaborone, Botswana. A 10-question multiple-choice question knowledge test, a 24-question 6-point Likert scale-based self-confidence assessment and a 7-point critical action simulation checklist were administered before and immediately after the course. Data analysis utilized descriptive statistics, paired t-test, Wilcoxon signed rank test and McNemar’s Exact test where appropriate. Feedback was analysed via thematic analysis. A total of 36 participants attended the IMEGH course. 34 participants completed demographic data and both the pre- and post-course knowledge tests. Mean knowledge improved significantly after course completion from 75.29% (95% CI [68.10%, 81.68%]) to 90% (95% CI [86.36%, 93.64%]). 32 participants completed both pre- and post-course self-confidence surveys. A statistically significant improvement in median self-confidence scores was observed for all 24 domains assessed (p<0.05). No difference was appreciated in pre- versus post-course simulation scores. Participant feedback highlighted the course strengths and opportunities for improvement. In this study, a modified IMEGH PALS training was associated with improved provider knowledge and self-confidence in paediatric resuscitation. The use of grouped simulation performance assessments limited the evaluation of individual participant competency in simulated scenarios. Future studies should include larger sample sizes, more diverse participant groups, assessments of long-term knowledge and skill retention as well as individualized simulation scoring and review.