Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training

Elizabeth A Hunt; Jordan M Duval-Arnould; Kristen L Nelson-McMillan; Jamie Haggerty Bradshaw; Marie Diener-West; Julianne S Perretta; Nicole A Shilkofski

doi:10.1016/j.resuscitation.2014.02.025

Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training

Resuscitation. 2014 Jul;85(7):945-51. doi: 10.1016/j.resuscitation.2014.02.025. Epub 2014 Mar 4.

Authors

Elizabeth A Hunt¹, Jordan M Duval-Arnould², Kristen L Nelson-McMillan³, Jamie Haggerty Bradshaw⁴, Marie Diener-West⁵, Julianne S Perretta⁶, Nicole A Shilkofski⁷

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, USA; Department of Pediatrics, USA; Division of Health Sciences Informatics, USA; Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA. Electronic address: ehunt@jhmi.edu.
² Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, USA; Division of Health Sciences Informatics, USA; Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA.
³ Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, USA; Department of Pediatrics, USA; Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA.
⁴ Uniformed Services of the Health Sciences, Bethesda, MD, USA.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, USA.
⁶ Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA.
⁷ Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, USA; Department of Pediatrics, USA; Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA; Perdana University Graduate School of Medicine, Kuala Lumpur, Malaysia.

PMID: 24607871
DOI: 10.1016/j.resuscitation.2014.02.025

Abstract

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: 8s (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.

Keywords: Cardiopulmonary resuscitation; Clinical competence; Defibrillator; Internship and residency; Medical education; Time-to-Treatment.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation / education*
Clinical Competence*
Education, Medical, Graduate / methods*
Electric Countershock
Female
Heart Arrest / therapy*
Humans
Internship and Residency
Male
Manikins
Pediatrics / education*
Prospective Studies
Resuscitation / education*
Survival Analysis
Time Factors