Use of High-Fidelity Simulation in the Setting of Pediatric Advanced Life Support Training to Improve Resident Choreography of Codes (1090-004326) (Research Abstract Oral: Resuscitation)
Start time: Monday, January 25, 2021, 3:30 PM End time: Monday, January 25, 2021, 4:30 PM Session Type: Research Abstracts (Completed Studies)
Simulation-based resuscitation programs have shown to increase resident confidence and improve outcomes in pediatric cardiopulmonary arrests (CPAs); however, less evidence exists on its use in teaching code choreography to prioritize interventions and communicate clearly within Pediatric Advanced Life Support (PALS) courses. Thus, we sought to determine if additional instruction in specific code choreography and action-linked phrases (ALPs) during initial PALS certification courses is associated with improved skill acquisition and retention when compared to residents taking the traditional course. Secondary aims include assessing resident confidence and medical knowledge in pediatric resuscitation.
First-year pediatric and emergency medicine residents completing the PALS course in summer 2019 participated in this prospective, randomized, pilot study. During the course, intervention groups were given a brief additional didactic session introducing specific code choreography and ALP techniques. Participants completed pre-/post-tests evaluating medical knowledge and a self-assessment regarding perception of one’s confidence during codes and effectiveness of the training. PALS testing scenarios used high-fidelity simulation and were recorded for review by blinded faculty. Resident groups were re-evaluated using similar assessment tools and recorded simulation scenario at 6 weeks and 3 months. Comparative tests for data analysis included independent t-test and ANCOVA.
20 pediatric and 14 emergency medicine interns participated. Resuscitation medical knowledge increased in all residents upon completion of the course (P=0.005). However, this was not sustained at 6 weeks or 3 months, as demonstrated in prior studies. Confidence assessment was similar between groups. Videos revealed shorter time to certain critical steps by the pediatric intervention groups. Mean time to start of compressions in pediatric control and intervention groups was 55 seconds and 32 seconds, respectively, though not statistically significant (P=0.168). Mean time to administration of first dose of cardiac arrest reversal agent was significantly shorter among pediatric intervention groups at 107 seconds, compared with the control groups at 183 seconds (P=0.025).
PALS training courses represent a unique opportunity to incorporate high-fidelity simulation to teach residents choreography and communication skills for the management of pediatric cardiopulmonary arrests.