TY - JOUR
T1 - Pediatric resident resuscitation skills improve after "Rapid Cycle Deliberate Practice" training
AU - Hunt, Elizabeth A.
AU - Duval-Arnould, Jordan M.
AU - Nelson-McMillan, Kristen L.
AU - Bradshaw, Jamie Haggerty
AU - Diener-West, Marie
AU - Perretta, Julianne S.
AU - Shilkofski, Nicole A.
N1 - Funding Information:
Dr. Hunt was funded by a Pearl Stetler Grant for Women Researchers and received NIH loan repayment in relation to the content of this manuscript. Dr Hunt also received grant funding for work unrelated to this project from the Laerdal Foundation for Acute Medicine, the Arthur Vining-Davis Foundation, the Hartwell Foundation and the American Heart Association. Mr Duval-Arnould is funded by a Hartwell Foundation grant, unrelated to this project. Dr Shilkofski has received funding from the Laerdal Foundation for Acute Medicine for work unrelated to this project. Dr Nelson-McMillan received funding from the Laerdal Foundation for Acute Medicine and the American Heart Association for work unrelated to this project. The remaining authors have no financial conflict of interest related to the content of this manuscript.
Funding Information:
The Pearl Stetler Foundation and the NIH Loan Repayment Program supported Dr. Elizabeth Hunt's contributions.
PY - 2014/7
Y1 - 2014/7
N2 - Introduction: Previous studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. "Milestones". We developed a simulation-based teaching approach "Rapid Cycle Deliberate Practice" (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. "first-five minutes" (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to "try again" over lengthy debriefing. Participants: Pediatric residents from an academic medical center. Methods: Prospective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. Results: Seventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre: 74% (5-100%) vs. post: 34% (26-53%); p<. 0.001)], no-blow fraction: [pre: 39% (22-64%) median (IQR) vs. post: 30% (22-41%); p= 0.01], and pre-shock pause: [pre: 84. s (26-162) vs. post: 8. s (4-18); p<. 0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within 1. min of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8 (95% CI: 2.0-7.2)] and defibrillating within 2. min: [HR: 1.7 (95% CI: 1.03-2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2. min: [HR: 2.8 (95% CI: 1.5-5.1)]. Conclusions: Implementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.
AB - Introduction: Previous studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. "Milestones". We developed a simulation-based teaching approach "Rapid Cycle Deliberate Practice" (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. "first-five minutes" (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to "try again" over lengthy debriefing. Participants: Pediatric residents from an academic medical center. Methods: Prospective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. Results: Seventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre: 74% (5-100%) vs. post: 34% (26-53%); p<. 0.001)], no-blow fraction: [pre: 39% (22-64%) median (IQR) vs. post: 30% (22-41%); p= 0.01], and pre-shock pause: [pre: 84. s (26-162) vs. post: 8. s (4-18); p<. 0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within 1. min of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8 (95% CI: 2.0-7.2)] and defibrillating within 2. min: [HR: 1.7 (95% CI: 1.03-2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2. min: [HR: 2.8 (95% CI: 1.5-5.1)]. Conclusions: Implementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.
KW - Cardiopulmonary resuscitation
KW - Clinical competence
KW - Defibrillator
KW - Internship and residency
KW - Medical education
KW - Time-to-Treatment
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U2 - 10.1016/j.resuscitation.2014.02.025
DO - 10.1016/j.resuscitation.2014.02.025
M3 - Article
C2 - 24607871
AN - SCOPUS:84902259831
SN - 0300-9572
VL - 85
SP - 945
EP - 951
JO - Resuscitation
JF - Resuscitation
IS - 7
ER -