Assessing pediatric senior residents' training in resuscitation: Fund of knowledge, technical skills, and perception of confidence

Objective: To describe pediatric housestaff knowledge, experience, confiden ce in pediatric resuscitations and their ability to perform important resus citation procedures during the usual training experience. Design and participants: Cohort study of PGY-3 level residents in a ACGME a ccredited pediatric residency training program at a large, tertiary care ch ildren's hospital. Methods: Fund of knowledge was assessed by administering the standardized t est from the Pediatric Advanced Life Support BALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. P rocedural skills were evaluated through observation of the resident perform ing four procedures during a skills workshop using a weighted step-wise gra ding sheet. Resident experience and confidence was quantified using an anon ymous survey. Results: Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2% +/- 5.5), but performed l ess well when answering more complicated questions (60.0% +/- 9.9) on the s hort answer test. No resident was able to successfully perform both basic a nd advanced airway skills, and only 11% successfully completed both vascula r skills. Although residents mere overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. Fo r example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedba ck on their performance less than half of the time. Over 89% of them felt t hat resuscitation knowledge and skill were important for their future chose n career. Conclusion: Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessar y resuscitation skills, few residents performed critical components of thes e skills correctly. Current pediatric residency training may not provide su fficient experience to develop adequate skills, fund of knowledge, or confi dence needed for resuscitation.