Pediatric residents experience a significant decline in their response capabilities to simulated life-threatening events as their training frequency in cardiopulmonary resuscitation decreases

Abstract

Objective: To determine the frequency of cardiopulmonary resuscitation education using high-fidelity patient simulators during pediatric residency training.

Design: Randomized controlled trial.

Setting: Suburban tertiary care children's hospital residency training program.

Subjects: Twenty-four second year pediatric residents.

Interventions: Twenty-four second year pediatric residents were randomized into two study groups, 12 residents in each. Both groups completed a formal resuscitation training course utilizing lectures, skill stations, and six scenarios on high-fidelity patient stimulators. Group A was retested on three scenarios 4 months after training and group B was similarly retested 8 months after training.

Measurements and main results: Time intervals from induction of a clinical problem to its definitive management were recorded for each resident. Residents were also asked to complete surveys following each episode of training and testing. The mean time intervals, for group A, to start effective bag mask ventilation and chest compressions in response to apnea and cardiac arrest were 17.75 secs (± 3.39 secs) and 23.42 secs (± 9.33 secs), respectively. These were significantly shorter than 32.7 secs (± 18.6 secs) and 81.2 secs (± 74.9 secs), for group B, respectively (p < .05). Residents in group A provided higher survey scores for their level of confidence in using cardiopulmonary resuscitation pharmacology than residents in group B did (p < .05). The two groups were no different in their response time to defibrillate or to start anti-arrhythmia medications for life-threatening arrhythmias and in their endotracheal intubation skills.

Conclusions: Pediatric residents show a significantly slower response time to effectively manage episodes of apnea and cardiac arrest 8 months after their initial resuscitation training, when compared to 4 months after training. These results may indicate that residents require more frequent training than currently recommended.