J Pediatr Intensive Care 2017; 06(01): 060-065
DOI: 10.1055/s-0036-1584678
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Lessons from the Design and Implementation of a Pediatric Critical Care and Emergency Medicine Training Program in a Low Resource Country—The South American Experience

Toni Biskup
1   Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador
2   Hospital de los Valles, Ecuador
Phillip Phan
3   The Johns Hopkins Carey Business School, Baltimore, Maryland, United States
4   Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
Michelle Grunauer
1   Department of Pediatrics, Universidad San Francisco de Quito Medical School, Cumbayá, Ecuador
2   Hospital de los Valles, Ecuador
3   The Johns Hopkins Carey Business School, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

24 June 2015

15 February 2016

Publication Date:
29 June 2016 (online)


For more than 60 years, the world has recognized the need for pediatric critical care (PCC). Today, most low- and middle-income countries (LMICs) still lack access to pediatric intensive care units (PICUs) and specialists, resulting in high rates of morbidity and mortality. These disparities result from several infrastructure and socioeconomic factors, chief among them being the lack of trained PCC and emergency medicine (PCCEM) frontline providers. In this article, we describe a continuing medical education model to increase frontline PCC capacity in Ecuador. The Laude in PCCEM is a program created by a team of Ecuadorian physicians at the University San Francisco de Quito School of Medicine. The program is aimed at providers with no formal training in PCC and who, nonetheless, care for critically ill children. The program resulted in stronger, more cohesive PICU teams with improved resuscitation times and coordination during simulation rounds. In hospitals that implemented the program, we saw decreased PICU mortality rates. Our aim is to identify the opportunities and challenges learned and to offer lessons for other countries that use similar models to cope with the lack of local resource availability.

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