643 - The development, validation and piloting of TAP-RLS: Training Assessment for Pediatric critical care in Resource Limited Settings.

Publication Number: 3623.643

Aly M.. Aly, University of Texas Southwestern Medical School, Dallas, TX, United States; Aya A.. Aly, Alexandria University Faculty of Medicine, Dallas, TX, United States; Ahmed Mamdouh, Beheira Specialized Children's Hospital, Beheira, Al Buhayrah, Egypt; Rehab Ragab Elseidy, St George's University Hospitals London, London, England, United Kingdom; Ahmed Asfari, University of Texas Southwestern Medical School, Allen, TX, United States; Amelie von Saint Andre-von Arnim, University of Washington School of Medicine, Seattle, WA, United States; Jombo Namushi, University of Texas Southwestern Medical School, Lusaka, Lusaka, Zambia; Matthew Borgman, University of Texas Southwestern Medical School, Dallas, TX, United States; Michael F. Canarie, Yale School of Medicine, New haven, CT, United States; Adam M. Silverman, Connecticut Children's, Hartford, CT, United States; Priya Prabhakaran, University of Alabama, Birmingham, Birmingham, AL, United States; Odiraa Nwankwor, Nemours Children's Hospital, Claymont, DE, United States; Roger Bedimo, University of Texas Southwestern Medical School, Dallas, TX, United States; Asya Agulnik, St. Jude Children's Research Hospital, Memphis, TN, United States; Adrian Holloway, University of Maryland Children's Hospital, Baltimore, MD, United States; Ayman Albalkhi, Damascus university, Damascus, Dimashq, Syria

Background: Pediatric patients with life-threatening illness in resource-limited settings (RLS) are often cared for by providers without formal pediatric critical care training. There is an urgent need to develop critical care training programs appropriate for RLS. However, the paucity of standardized needs and evaluation tools for RLS highlights an opportunity for improvement.

Objective: We aim to develop, validate, and pilot a tool, TAP-RLS: Training Assessment for Pediatric Critical Care, to assess the adequacy and relevance of essential components of pediatric critical care training in RLS. Additionally, we seek to identify and describe disparities in training and educational infrastructure across RLS.

Design/Methods: The development and validation of the tool follow three phases: Conception, Consensus, and Circulation. (Figure 1) Through a scoping literature review (2000-2024), we identified existing training assessments and validated frameworks (e.g. ACGME milestones) to structure the TAP-RLS. The tool underwent iterative revisions through structured feedback using a modified Delphi process with 13 international pediatric critical care experts to ensure content validity and contextual relevance. A user-centered design was incorporated through consultations with site leads from RLS to enhance clarity, feasibility, and applicability. The TAP-RLS will be pilot tested to assess face validity, usability, and alignment with local training needs. Participating sites were required to meet the 2014 CHEST consensus criteria for RLS and the World Bank classification for Low-middle income countries, with participants self-identifying as physicians caring for acutely critically ill pediatric patients. (Figure 2)

Results: Of 198 articles screened, 51 were included to inform the conceptual framework of TAP-RLS. The tool consists of 5 domains with 178 items. In the first round of Delphi consensus, 92% (n=12) of experts participated, with 87% (n=155) of items rated as "important", 3.7% (n=7) as "absolutely essential", and 8.3% (n=15) as "desirable". Only one question was deemed "unnecessary". (Figure 3) Additional feedback further condensed the tool to 97 items. Six sites across Egypt, Sudan, Syria, Yemen, Zambia and Nigeria have been recruited for the pilot phase.

Conclusion(s): We propose a tool to assess pediatric critical care training and educational infrastructure in RLS. Given expert consensus, the tool should capture disparities in training across different RLS settings.

Figure 1: Development and Validation model for TAP-RLS
The three stages of development (Conception, Consensus, and Circulation) and five domains of TAP-RLS using the Delphi process.

Figure 2: TAP-RLS sites enrollment
This flow diagram illustrates the site selection process starting with five initial sites, two sites withdrew due to regional conflict. One site was excluded due to language criterion. The project currently has three sites in discussion and anticipates a total of six sites for piloting.

Figure 3: Delphi process round 1 results
Stage 2 Delphi Consensus Round 1 Results. It highlights the level of agreement among experts in the initial round, moving the process toward refining the remaining items in subsequent rounds.