Evaluation of Resuscitation Skills in New Residents Before and After Pediatric Advanced Life Support Course

Abstract

ABSTRACT. Objective. Acquisition of resuscitation skills taught in advanced resuscitation courses has not been evaluated. We sought to determine the interobserver reliability of a resuscitation performance skills checklist to assess resident performance of bag mask ventilation, intubation, defibrillation, and intraosseous vascular access, and to measure skill acquisition by entering residents after a pediatric advanced life support (PALS) course.Design. The resuscitation skills of all 39 pediatric R1's in 2 university-based training programs were assessed immediately before and after completion of a PALS course just before starting residency. Independent observers scored and timed resident performance of bag mask ventilation, endotracheal intubation, intraosseous access, and defibrillation. Scores before and after the PALS course were compared. Four independent observers scored 4 residents' videotaped skills performance. Observers' scores for each resident were compared.Results. Successful performance improved for bag mask ventilation from 62% to 97% after the PALS course; for successful endotracheal intubation, from 64% to 90%; for successful intraosseous needle placement, from 54% to 92%; and for successful defibrillation, from 77% to 97%. Interobserver reliability was high for continuous and noncontinuous variables.Conclusions. New residents demonstrated significant acquisition of pediatric resuscitation skills immediately after completion of the PALS course. The skills performance checklist has excellent interobserver reliability and is a useful tool for evaluation of other training venues. Pediatrics 2001;108(6). URL: http://www.pediatrics. org/cgi/content/full/108/6/e110; resuscitation, education, advanced life support, training.ABBREVIATIONS. AHA, American Heart Association; PALS, pediatric advanced life support; BVMV, bag valve mask ventilation; ACLS, advanced cardiac life support. N ationally recognized pediatric resuscitation courses for medical professionals have existed for over 20 years and have become standards in residency training. The American Heart Association's (AHA) Pediatric Advanced Life Support (PALS) course is required in 99% of US pediatric residency programs. 1 Washington state laws require PALS training of care providers in all hospitals participating in the pediatric trauma designation system. However, the efficacy of PALS courses has not yet been well-evaluated.Advanced resuscitation courses teach both cognitive knowledge and psychomotor skills. Assessment of students' cognitive knowledge acquisition is accomplished by written examinations for which specific pass grades are established. On the other hand, assessment of complex psychomotor skills, such as intubation and bag valve mask ventilation (BVMV), is less structured and allows for greater instructor variability in assessing students' competency. 2 Furthermore, there are no standard, objective, validated, uniformly accepted methods of assessing competency in these technical skills. Reliable, objective measures are needed.In a pr...

High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

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