1284: EFFECTIVENESS AND FEASIBILITY OF SIMULATION FOR PICU PROVIDERS IN LMICS: A SYSTEMATIC REVIEW

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Introduction: Simulation-based medical education (SBME) improves clinical performance and team dynamics in pediatric intensive care units (PICUs). Although widely implemented in high-income countries, SBME remains underutilized in low- and middle-income countries (LMICs) due to contextual challenges. We conducted a systematic review to evaluate the effectiveness and feasibility of SBME for PICU providers in LMICs, focusing on reported outcomes and implementation barriers. Methods: We searched PubMed, Scopus, Cochrane, and CINAHL through January 2024. Of 2,162 screened articles, 278 duplicates were removed and 16 studies met inclusion criteria. ROBINS-I assessed risk of bias: 15 studies had moderate risk and one had low risk. Meta-analysis was not feasible due to outcome heterogeneity and study quality. Results: Sixteen studies from 14 LMICs were included, primarily from South Asia, sub-Saharan Africa, and Southeast Asia, with additional representation from China, Turkey, Belize, Ghana, and Jamaica. Sample sizes ranged up to 2,698 participants; most studies enrolled fewer than 50 learners (n=11), including pediatric residents, nurses, generalist providers, and multidisciplinary teams. Simulation modalities included high-fidelity manikins, telesimulation, and task trainers. The most frequent assessments were written pre/post-tests and OSCE-style checklists (n=9 each), followed by confidence surveys. Most studies used pre-post designs (n=9). SBME was associated with improvements in clinical knowledge (n=12), procedural skills (n=7), teamwork (n=8), and confidence (n=12); four studies also reported improved clinical outcomes. Feasibility was addressed in over half the studies, often highlighting adaptability of low-cost or digital formats. Key barriers included limited simulation infrastructure (n=7), time constraints (n=6), lack of simulation exposure (n=4), and broader contextual limitations. Conclusions: SBME enhances critical competencies in PICU providers in LMICs but is constrained by systemic barriers and methodological limitations. Future efforts should prioritize faculty training, protected teaching time, and context-specific curricula. As a scalable tool, SBME represents a valuable investment in global pediatric critical care.

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