(1063) Implementing a Skills Refresher System in a Pediatric Residency Curriculum for Crisis Management

Introduction: Resuscitation of an acutely ill child is a necessary skill for pediatric residents. Mock codes and simulation are essential in the curriculum, given a new proposal for reduced time in the PICU. We and others describe that the resident’s mastery level of psychomotor skills decays within 4-8 weeks. Implementing a simulation program with protected time to “refresh” skills before decay is feasible and sustainable in a midsize pediatric residency program.

Methods: Our team began an implementation process as a quality improvement project in 2019 in a community university-affiliated PICU. A validated crisis management tool TPDSCI (team performance during simulated crises instrument), was used at monthly mock codes and refresher sessions for psychomotor skills. The dissemination of information for the implementation progress was done during attending-resident staff meetings, unit-based team meetings, clinical service committees for quality improvement, and grand rounds. A tracking system and evaluation incorporated into the curriculum MedHub facilitated self-reporting. We aimed for a refresher rate of 80% per resident in 4 skills: IO placement, BMV, Chest compressions, and ET intubation. In 3 years, we report exposure over three 9-month cycles.

Results: We recorded an implementation timeline and reported in 2-month phases. In the first phase, we met with stakeholders and department leaders to agree on the duration, frequency, and time for simulation sessions. A needs assessment survey, scenario leaders, assessment tool, and IRB approval were completed in phase 2. The Covid-19 pandemic prolonged phase 3. In July 2020, a well-established system was in place to capture all the designated skills. At the end of the first cycle, 8% of the residents reached the set exposure threshold for IO; 4% for BMV; 20% for intubation; 8% for chest compression (CC). At cycle II 6% for IO; 37 for BMV; 40% for intubation; 12% for CC. At cycle III 37% for IO; 34% for BMV; 6% for intubation.

Conclusions: A refresher system with self-reporting was implemented on four psychomotor skills in three 9-month cycles. Facing reduced training time in critical care areas, educators must maintain psychomotor skills for all team members, including pediatric residents, especially those training in community hospitals.