Designing contextually relevant emergency medicine simulation-based learning experiences for paediatric specialist training in South Africa: a narrative review

Pediatric trainees in South Africa must acquire competence in managing life-threatening conditions to qualify as specialists, although limited supervision, inconsistent feedback in clinical settings, high clinical workloads, and local healthcare realities often impede learning. Simulation-based learning experiences (SBLEs) provide a safe environment for deliberate practice, feedback, and reflective learning. A South African university introduced time during the academic postgraduate program for simulation-based training for pediatric emergency medical conditions. The aim was to design context-specific SBLEs for pediatric emergency medicine training in South Africa, informed by the local burden of disease and aligned with program learning outcomes. A narrative review of publications in English from 2000 onward was conducted using multiple databases to describe patterns of pediatric morbidity and mortality in South African hospitals. Eligible publications included data from emergency centers, wards, high-care units, and intensive care units relating to case mixes and emergency presentations. The review findings guided the development of five medical SBLEs within a design-based research framework to allow for further iterative refinement in the program. Twenty-eight studies met the inclusion criteria. Respiratory illnesses accounted for approximately 42% of admissions, followed by neurological (12%), cardiovascular (11%), gastrointestinal (7%), and septic (12%) conditions. Malnutrition was a frequent comorbidity across all settings. These data informed the design of five SBLEs focusing on (i) respiratory failure and difficult airway management, (ii) convulsive status epilepticus with hypoglycemia, (iii) severe acute malnutrition with gastroenteritis and hypokalaemia, (iv) sepsis and application of the Phoenix criteria, and (v) bradycardia with transcutaneous pacing. This narrative review used South African pediatric morbidity and mortality data to inform the design of five contextually relevant simulation-based learning experiences for postgraduate training. Developed within a design-based research framework, this potentially transferable approach aims to strengthen technical and non-technical competencies for safer practice in resource-constrained settings.