How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate?

Abstract

Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.

Improving the Performance of Residents in Pediatric Resuscitation with Frequent Simulated Codes

“…In our previous study, we found pediatric residents' code team leadership skills markedly declined within 8 months of their last PALS certification. 20 Our results showed that increasing the frequency of mock codes during pediatric residency training from monthly to weekly, improved pediatric senior residents' team leader performance scores. Residents performed more effectively as code team leaders and the improvement was significant both for the leadership and for their overall performance scores during the mock code.…”

“…In our previous study, we found pediatric residents’ code team leadership skills markedly declined within 8 months of their last PALS certification. 20 …”

“…This is crucial because the success of a code is directly related to the knowledge and performance of the code leader. 20 , 23 A code team leader orchestrates the code by giving instructions to other code team members, providing guidance and supervision to members of the team and ensuring that the necessary tasks are completed correctly during resuscitation. Codes led by strong team leaders were found to be more efficient in completing the necessary tasks with fewer mistakes.…”

Pediatic code blue event analysis: Performance of non-acute health-care providers

“…Studies have shown poor retention of knowledge and skills with the current resuscitation training approaches [ 21–24 ]. Declines in knowledge and technical skills have been shown to occur within months of PALS training [ 24 , 25 ]. Our results are therefore unsurprising, and the deviations from established resuscitation guidelines may reflect a systemic issue with regard to our current approaches to resuscitation training.…”

A Narrative Review of Training Approaches to Address Low Volume High Risk Pediatric Resuscitation Skills

“…critical appraisal of the body of literature that compared the effect of training frequency on CPR skill performance, authors concluded, "there is insufficient evidence to confirm an optimal training frequency… [however], annual resuscitation training is insufficient to maintain effective CPR skill performance" [6] (p.823). Similarly, Doymaz, et al [8] assessed pediatric residents' retention of knowledge and clinical skills over time following AHA PALS [5] certification. Authors discovered that participants' clinical skills performance declined within the and Illinois Emergency Medical Services for Children [12]), including fully developed scenarios, extremely valuable.…”