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Pediatr Emerg Care. 2020 Jan 27. doi: 10.1097/PEC.0000000000001996. [Epub ahead of print]

Simulation and Active Learning Decreases Training Time of an Emergency Triage Assessment and Treatment Course in Pilot Study in Malawi: Implications for Increasing Efficiency and Workforce Capacity in Low-Resource Settings.

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From the University of Calgary, Calgary, Alberta, Canada.
Ministry of Health, Lilongwe, Malawi.
Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada.
Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL.
The Wilson Centre for Research in Education, University of Toronto, Calgary, Alberta, Canada.
Bristol Medical Simulation Centre, Bristol, United Kingdom.
Simulation Program, Division of Critical Care Medicine, Department of Anesthesia Critical Care and Perioperative Medicine, Boston Children's Hospital.
Harvard Medical School, Boston, MA.
Department of Emergency Medicine, Interprofessional Education Cumming School of Medicine, Calgary, Alberta, Canada.
College of Medicine, University of Blantyre, Blantyre, Malawi.
British Columbia Children's Hospital.
Department of Pediatrics and Emergency Medicine, Sunny Hill Health Centre for Children, University of British Columbia, Vancouver, British Columbia, Canada.



The aim of the Emergency Triage Assessment and Treatment (ETAT) plus trauma course is to improve the quality of care provided to infants and children younger than 5 years. The curriculum was revised and shortened from 5 to 2.5 days by enhancing simulation and active learning opportunities. The aim of this study was to examine the feasibility and value of the new short-form ETAT course by assessing postcourse knowledge and satisfaction.


We delivered the short-form ETAT course to a group of interdisciplinary health workers in Malawi. Precourse and postcourse knowledge was assessed using a standardized 20 questions short answer test used previously in the 5-day courses. A 13-statement survey with 2 open-ended questions was used to examine participant satisfaction.


Participants' postcourse knowledge improved significantly (P < 0.001) after the shorter ETAT course. Participants reported high levels of satisfaction with the short-form ETAT.


Simulation and other active learning strategies reduced training time by 50% in the short-form ETAT course. Participants with and without previous ETAT training improved their knowledge after participating in the short-form ETAT course. Reduced training time is beneficial in settings already burdened by scarce human resources, may facilitate better access to in-service training, and build capacity while conserving resources in low-resource settings.

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