J Pediatr Intensive Care 2023; 12(04): 271-277
DOI: 10.1055/s-0041-1731787
Original Article

Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest

Nancy M. Tofil
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Charli Cohen
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Carrie Norwood
2   Children's of Alabama, Pediatric Simulation Center, Birmingham, Alabama, United States
,
Jerry Lynn Zinkan
2   Children's of Alabama, Pediatric Simulation Center, Birmingham, Alabama, United States
,
Sai S. Raju
3   Department of Pediatrics, University of Texas at Austin, Austin, Texas, United States
,
Chrystal Rutledge
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
› Author Affiliations
Funding This study was partially funded by Department of Pediatrics Founders Fund Grant, University of Alabama at Birmingham.

Abstract

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days–3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups (p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups (p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.



Publication History

Received: 18 March 2021

Accepted: 29 May 2021

Article published online:
08 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Accreditation Council for Graduate Medical Education Pediatric Requirements. ACGME program requirements for graduate medical education in pediatrics. Assessed December 24, 2020 at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_Pediatrics_2020.pdf?ver=2020-06-29-162726-647
  • 2 Kleinman ME, Chameides L, Schexnayder SM. et al. Pediatric advanced life support 2010 AHA guidelines. Circulation 2010; 122 (Suppl. 03) S876-S908
  • 3 Waisman Y, Amir L, Mimouni M. Does the pediatric advanced life support course improve knowledge of pediatric resuscitation?. Pediatr Emerg Care 2002; 18 (03) 168-170
  • 4 Durojaiye L, O'Meara M. Improvement in resuscitation knowledge after a one-day paediatric life-support course. J Paediatr Child Health 2002; 38 (03) 241-245
  • 5 Grant EC, Marczinski CA, Menon K. Using pediatric advanced life support in pediatric residency training: does the curriculum need resuscitation?. Pediatr Crit Care Med 2007; 8 (05) 433-439
  • 6 White JRM, Shugerman R, Brownlee C, Quan L. Performance of advanced resuscitation skills by pediatric housestaff. Arch Pediatr Adolesc Med 1998; 152 (12) 1232-1235
  • 7 Jani P, Blood AD, Park YS, Xing K, Mitchell D. Simulation-based curricula for enhanced retention of pediatric resuscitation skills: a randomized controlled study. Pediatr Emerg Care 2019; 37 (10) e645-e652
  • 8 Anderson R, Sebaldt A, Lin Y, Cheng A. Optimal training frequency for acquisition and retention of high-quality CPR skills: a randomized trial. Resuscitation 2018; 13: 156-161
  • 9 Lin Y, Cheng A, Grant VJ, Currie GR, Hecker KG. Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers - A randomized controlled trial. Resuscitation 2018; 130: 6-12
  • 10 Swinger ND, Rutledge C, Gaither S. et al. Rapid cycle deliberate practice improves and sustains paediatric resident PALS performance. BMJ Simulat Technol Enhanced Learning 2020; 6: 257-261
  • 11 Raju S, Tofil NM, Gaither S. et al. The role of rapid cycle deliberate practice to improve pediatric intern code skills. Sim Healthcare. 2020. . PMID 33370083
  • 12 Donoghue A, Nishisaki A, Sutton R, Hales R, Boulet J. Reliability and validity of a scoring instrument for clinical performance during pediatric advanced life support simulation scenarios. Resuscitation 2010; 81 (03) 331-336
  • 13 Levy A, Donoghue A, Bailey B. et al. External validation of scoring instruments for evaluating pediatric resuscitation. Simul Healthc 2014; 9 (06) 360-369
  • 14 Kaczorowski J, Levitt C, Hammond M. et al. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Fam Med 1998; 30 (10) 705-711
  • 15 Falck AJ, Escobedo MB, Baillargeon JG, Villard LG, Gunkel JH. Proficiency of pediatric residents in performing neonatal endotracheal intubation. Pediatrics 2003; 112 (6, pt 1): 1242-1247
  • 16 Hunt EA, Duval-Arnould JM, Nelson-McMillan KL. et al. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation 2014; 85 (07) 945-951
  • 17 Chancey RJ, Sampayo EM, Lemke DS, Doughty CB. Learners' experiences during rapid cycle deliberate practice simulations: a qualitative analysis. Simul Healthc 2019; 14 (01) 18-28
  • 18 Lemke DS, Fielder EK, Hsu DC. et al. Improved team performance during pediatric resuscitations after rapid cycle deliberate practice compared with traditional debriefing: A pilot study. Pediatr Emerg Care 2019; 35 (07) 480-486
  • 19 Magee MJ, Farkouh-Karoleski C, Rosen TS. Improvement of immediate performance in neonatal resuscitation through rapid cycle deliberate practice training. J Grad Med Educ 2018; 10 (02) 192-197
  • 20 Cory MJ, Colman N, McCracken CE, Hebbar KB. Rapid cycle deliberate practice versus reflective debriefing for pediatric septic shock training. Pediatr Crit Care Med 2019; 20 (05) 481-489
  • 21 Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. Deliberate practice using simulation improves neonatal resuscitation performance. Simul Healthc 2011; 6 (06) 327-336
  • 22 Ericsson KA. The influence of experience and deliberate practice on the development of superior expert performance. In: Ericsson KA, Charness N, Hoffman RR, Feltovich PJ. eds. The Cambridge Handbook of Expertise and Expert Performance. New York, NY: Cambridge University Press; 2006: 683-703
  • 23 McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011; 86 (06) 706-711
  • 24 Quan L, Shugerman RP, Kunkel NC, Brownlee CJ. Evaluation of resuscitation skills in new residents before and after pediatric advanced life support course. Pediatrics 2001; 108 (06) E110
  • 25 Hunt EA, Patel S, Vera K, Shaffner DH, Pronovost PJ. Survey of pediatric resident experiences with resuscitation training and attendance at actual cardiopulmonary arrests. Pediatr Crit Care Med 2009; 10 (01) 96-105
  • 26 Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR. Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 2000; 16 (02) 73-76
  • 27 Nadkarni VM, Larkin GL, Peberdy MA. et al; National Registry of Cardiopulmonary Resuscitation Investigators. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295 (01) 50-57