Hypothesis Pediatric codes are not common, so training opportunities are limited to simulation-based training. Simulation-based pediatric mock code curricula have demonstrated their educational1-2 impact on clinical outcomes.3 A simulation-based Clinical Resuscitation Skills curriculum allows trainees to assume the leadership role during a pediatric code in a safe environment. To assess code leadership skills, an assessment form was created to be completed by the trainee, their peers and a faculty evaluator. We hypothesize mock code simulation with immediate assessment will identify trainee performances gaps to guide timely remediation. Methods This proposal retrospectively reviews the assessments of mid and senior level trainees in pediatric code resuscitation skills from October 2008-December 2012. Participating trainees were either midlevel or senior residents within both Pediatrics and Medicine/Pediatrics programs at our institution. Trainees performed at least 1 mock code during their residency. The majority of the mock codes took place within our Clinical Simulation Center without prior warning to the trainees. A variety of simulation manikins were used for the testing, and scenarios included standard practice of airway skills, rhythm recognition, hemodynamic assessment, and global patient evaluation. The assessment tool consisted of eight items rated on 5-point scales ranging from 1(unacceptable) to 5 (outstanding). A many-facet Rasch model4 was used to compare faculty and residents’ self-reported performance ratings, evaluate learner performance over time, and identify performance differences across trainee level. Results One hundred thirty-seven trainees tested over the four-year period. Results indicated majority of the trainees performed well, but self-reported their performances lower than the evaluator (3.8 vs 4.3, p<0.01). With an increase in frequency and consistency of the mock codes after the first year, significant improvement in the trainee performance was observed (4.2 for 2009 vs 4.4 for 2010-12, p<0.01). The assessment tool was successfully able to differentiate between midlevel and senior residents’ performance with the midlevel residents averaging 4.2 and the senior residents averaging 4.4 (p<0.01). Findings indicated that Med/Peds residents had slightly higher (4.4) averaged scores than Pediatric residents (4.3), p<0.001. Conclusion With the paucity in pediatric codes, simulation is becoming the gold standard in preparing trainees to successfully lead pediatric codes. The assessment tool used in this study adequately measured trainees’ leadership skills. It also differentiated between midlevel and senior residents, and identified trainees who required remediation. This tool can also be for ongoing program evaluation.
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