A Simulator-Based Tool That Assesses Pediatric Resident Resuscitation Competency

Abstract

Competency in pediatric resuscitation is an essential goal of pediatric residency training. Both the exigencies of patient care and the Accreditation Council for Graduate Medical Education require assessment of this competency. Although there are standard courses in pediatric resuscitation, no published, validated assessment tool exists for pediatric resuscitation competency. The purpose of this work was to develop a simulation-based tool for the assessment of pediatric residents' resuscitation competency and to evaluate the tool's reliability and preliminarily its validity in a pilot study. We developed a 72-question yes-or-no questionnaire, the Tool for Resuscitation Assessment Using Computerized Simulation, representing 4 domains of resuscitation competency: basic resuscitation, airway support, circulation and arrhythmia management, and leadership behavior. We enrolled 25 subjects at each of 5 different training levels who all participated in 3 standardized code scenarios using the Laerdal SimMan universal patient simulator. Performances were videotaped and then reviewed by 2 independent expert raters. The final version of the tool is presented. The intraclass correlation coefficient between the 2 raters ranged from 0.70 to 0.76 for the 4 domain scores and was 0.80 for the overall summary score. Between the 2 raters, the mean percent exact agreement across items in each domain ranged from 81.0% to 85.1% and averaged 82.1% across all of the items in the tool. Across subject groups, there was a trend toward increasing scores with increased training, which was statistically significant for the airway and summary scores. In this pilot study, the Tool for Resuscitation Assessment Using Computerized Simulation demonstrated good interrater reliability within each domain and for summary scores. Performance analysis shows trends toward improvement with increasing years of training, providing preliminary construct validity.