title: Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: 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.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: 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.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Duval-Arnould
authors.affiliation: 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.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Nelson-McMillan
authors.affiliation: Uniformed Services of the Health Sciences, Bethesda, MD, USA.
authors.forename: Jamie Haggerty
authors.initials: JH
authors.lastname: Bradshaw
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.affiliation: Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA.
authors.forename: Julianne S
authors.initials: JS
authors.lastname: Perretta
authors.affiliation: 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.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Shilkofski
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004554:Electric Countershock; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D010372:Pediatrics / Q000193:education*; D011446:Prospective Studies; D012151:Resuscitation / Q000193:education*; D016019:Survival Analysis; D013997:Time Factors
keywords: Cardiopulmonary resuscitation; Clinical competence; Defibrillator; Internship and residency; Medical education; Time-to-Treatment