PeTIT | Pediatric Trauma Innovation Team

Pediatric trauma remains a neglected disease in resource-limited settings. Education is the most critical intervention to address pediatric trauma; nevertheless, effective training programs are absent in LMICs. 

Our objective is to develop virtual reality and online course in pediatric trauma skills designed for general surgeons, who are the primary providers handling pediatric trauma in most LMICs. These providers are often well-skilled in adult trauma assessment, but experience frequent deficiencies in managing children's unique anatomic and physiologic features and in performing essential trauma interventions in children, such as vascular access and chest tube insertion.

Through a series of virtual modules, our course will provide expert content through lectures, videos, and finally, a virtual simulated-scenario for "hands-on" practice. The course includes Instant feedback and a pre/post-self-assessment questionnaire, allowing participants to evaluate themselves and learn at their pace.

Brazilian general surgeons will test our prototype/solution at first hand in a busy trauma center.

Our module will be a remotely-delivered online and virtual reality (VR) pediatric trauma course in Portuguese, accessible through mobile apps or computer software with any VR device.

We would organize it in several sections corresponding to critical problems and essential surgical procedures in pediatric trauma. In each section, the student will meet the educational goals by:

• completing a self-assessment questionnaire and pre-test to assess their current knowledge; 
• watch relevant lectures and demonstrations; 
• practice using trauma assessment simulated-scenarios; 
• conduct relevant minor surgical interventions; and 
• complete a post-test and self-assessment questionnaire.

For the overall assessment and the specific procedure tasks, trainees would use a realistic role-playing game will test for decision-making skills at each critical step. Depending on each decision made, the narrative will progress based on built-in algorithms until reaching a clinical outcome.

In the case of surgical interventions, the pedagogical focus will be on differences in anatomy, physiology and instrumentation between adults and children. As our target user population already has good baseline psychomotor skills and are only missing the translation of these skills to the pediatric patient population, VR will fill this knowledge gap. After the course, users will be able to achieve mastery in the proposed psychomotor skills. 

An educationally sound surgical education module includes theoretical knowledge, technical skills, and non-technical (decision-making) skills.

We are aiming to use lectures and video demonstrations to increase the students' knowledge about pediatric trauma.

In the practical sessions, students will have the opportunity to practice being a trauma team leader. They will make critical decisions at each step of the management and will lead their virtual team through a simulated scenario.

Ample pediatric trauma technical skills taught in each module would allow students to interpret radiologic exams and virtually perform surgical interventions. The latter will require identifying anatomic landmarks, choosing surgical instruments, and determining the steps needed for successful task completion. It is important to note that depending on the patient's age, the landmarks, devices used, and steps to follow can be different - making pediatric trauma management more challenging than in adults.

These are the practical skills students will learn:

1. Neck immobilization.
2. Airway management.
3. Chest tube insertion.
4. Central venous and intraosseous access.
5. Interpretation of a FAST exam and reading chest and pelvic X-rays and head, chest, and abdominal CT scans.
6. Pelvic stabilization.
7. Fracture alignment.
8. General trauma assessment, following the ABCDE protocol (standard prioritized trauma protocol).

Our project focuses on general surgeons and surgical trainees, who assess pediatric trauma patients in busy trauma centers in Latin America. These centers focus on treating adult patients, and their providers often do not have adequate training in pediatric trauma and are not familiar with children's physiology and anatomy. Thus, resulting in low provider confidence in managing pediatric trauma and low quality of care. Performing an average of 34% of essential steps when these providers assess an injured child, and more than 80% of them declared that a pediatric trauma course is needed.

These surgeons are technically skillful in managing adult patients due to the high number of cases they face every day. Thus, their specific needs in pediatric trauma are for better understanding:

1. the particularities of children's anatomy and physiology, 
2. common patterns of trauma mechanisms in children, and 
3. the selection of adequate surgical instruments and devices based on age. 

Where resources are constrained, VR environments also offer the advantages of being immersive, and allow deliberate practice.

Finally, there will be a package of surgical education tools to ensure self-assessment throughout the course: (1) theoretical exams; (2) self-assessment questionnaires; (3) feedback during the scenario; and (4) metrics of user’s performance.

Clinician

• Dr Botelho, MD is a Brazilian pediatric surgeon and a pediatric trauma expert. Currently, he is also a Fellow of Montreal Children's Hospital.
• Dr. Luiz Teixeira, MD is a trauma surgeon from Hospital João XXIII.
• Dr. Costas, MPH, MD is a general surgeon and surgical educator from Rwanda. 

Surgical Educators

• Dr Poenaru, MD, PhD, is an expert in surgical education and global health. He is a pediatric surgeon and researcher at McGill University.
• Dr Abib, MD, PhD is a pediatric surgeon, trauma expert and teacher. Safe Kids Brazil coordinator.
• The Program in Global Surgery and Social Change (PGSSC) from Harvard Medical School, represented by Ms Buda, is a partner in this project.

Technical Expert

• Mr Baldizon is a technician expert form Guatemala, founder of Silibrain LLC to build apps, websites, and software solutions for traditional industries, such as healthcare
• Dr. Bloomfield, PhD is a neuroscientist from Imperial College London and run programmes to support early-stage startups and advised the UK and international governments on technology policy and strategy.

Designer and Social Media

• Mr. França is a last-year designer student at UFMG, Brazil.
• Mr. Rech is a Brazilian medical student.