Resident Performance of the Rapid Cardiopulmonary Assessment in the Emergency Department

Abstract

Objectives The rapid cardiopulmonary assessment (RCPA) is an essential first step in effective resuscitation of critically ill children. Pediatric residents may not be achieving competency with resuscitative skills, including RCPA. Our objective was to determine how often pediatric residents complete the RCPA for actual patients. Methods This was an observational, cross-sectional study of senior residents (≥postgraduate year 2) performing the RCPA in the resuscitation area of a high-volume pediatric emergency department (PED), where pediatric residents are expected to perform the bedside examination and assessment for all medical (nontrauma) patients. Data were collected primarily by video review on a standard form. The primary outcome was completion of the RCPA, defined as both examination and verbalized assessment of the airway, breathing, and circulation. We explored the association between RCPA completion and both residency year and number of previous PED rotations. Results Complete data were collected from one randomly selected patient for 71 (95%) of 75 of eligible senior residents who rotated in the PED between January and June 2013. Two residents (3%) performed a complete RCPA. Verbalized assessment of circulation was especially rare (7/71; 10%). There was no association between RCPA completion and year of training or previous PED experience (P > 0.05). Conclusions Senior pediatric resident performance of the RCPA in the resuscitation area of a high-volume PED was poor. There was no association between RCPA completion and greater resident experience, including in the PED. These findings add to a growing body of literature suggesting that pediatric residents are not achieving competency with the RCPA and resuscitation skills.

Performance evaluation of standardized residency training based on non-parametric intelligent group decision method

“…These residents typically encounter fewer cases of cardiac arrest and consequently engage in less clinical practice, leading to a lower proficiency in CPR skills. Incorporating CPR as an assessment criterion can significantly enhance residents' emergency skills, ultimately contributing to the improved prognosis of critically ill children [18] .…”

Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam

“…At our institution, Sobolewski et al found that senior pediatric residents do not promptly nor thoroughly perform an initial RCPA on actual patients in the resuscitation area despite it being an expectation. 3 In this historical cohort, 6 (8.4%) of 71 senior residents assessed via video review completed any component of the perfusion exam and 7 (9.8%) of 71 verbalized their assessment of perfusion. 3 Experience and repetition of clinical assessments have been shown to improve exam skills; but pediatric residents have limited clinical opportunities to apply them in patients at risk for or in shock.…”

“…3 In this historical cohort, 6 (8.4%) of 71 senior residents assessed via video review completed any component of the perfusion exam and 7 (9.8%) of 71 verbalized their assessment of perfusion. 3 Experience and repetition of clinical assessments have been shown to improve exam skills; but pediatric residents have limited clinical opportunities to apply them in patients at risk for or in shock. 4,5 Educators have attempted to address this experience gap through high-fidelity simulation, which leads to increased skill retention compared with didactic training and lower-fidelity simulation.…”

“Sim One, Do One, Teach One”

“…1 Observational studies have shown that senior residents in the pediatric emergency department (PED) have poor performance and limited exposure to rapid cardiopulmonary assessment of critically ill patients. 2 One survey of pediatric senior residents showed that only 22% had been the first responder to an actual patient resuscitation and 44% reported they had never led a resuscitation during residency. 3 Without this adequate experience, pediatric physicians may not feel comfortable appropriately caring for these patients after residency.…”

“…In pediatrics, the “do one” aspect of this learning triad often becomes a rate-limiting step, especially when it comes to the resuscitation of critically ill patients, as pediatric medical and traumatic emergencies are less common than those in adult medicine 1 . Observational studies have shown that senior residents in the pediatric emergency department (PED) have poor performance and limited exposure to rapid cardiopulmonary assessment of critically ill patients 2 . One survey of pediatric senior residents showed that only 22% had been the first responder to an actual patient resuscitation and 44% reported they had never led a resuscitation during residency 3 .…”