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The Effects of an Intervention

Frances M. Nadel, MD; Jane M. Lavelle, MD; Joel A. Fein, MD; Angelo P. Giardino, MD, PhD; Joanne M. Decker, MD; Dennis R. Durbin, MD, MSCE

Arch Pediatr Adolesc Med. 2000;154:1049-1054.

Objective  To evaluate the effectiveness of an educational intervention on pediatric residents' resuscitation fund of knowledge, technical skills, confidence, and overall performance.

Design  Prospective, nonconcurrent, controlled interventional trial.

Setting  Urban pediatric tertiary care hospital.

Participants  An intervention group (IG) of 28 pediatric residents graduating in 1997, and a control group (CG) of 30 pediatric residents graduating in 1996.

Interventions  Resuscitation course with didactic lectures and skills practice stations, as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3.

Main Outcome Measures  Fund of knowledge, using the Pediatric Advanced Life Support test and short answer test; technical skills, using the Airway and Vascular Access Skills Assessment; experience and confidence, using an anonymous survey; and overall performance, evaluated using a videotaped mock resuscitation test.

Results  The IG scored better on the short answer test (P<.001). A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access (P = .02), as well as endotracheal intubation (P = .004) and intraosseous access (-/P = .002). The IG was more confident in their leadership role (P = .0001) and technical skills (P = .05). Trends toward improved overall performance were noted for the IG mock resuscitations. Residents in the IG were more likely to assess the airway in fewer than 2 minutes (P = .02), recognize the threat to life in fewer than 5 minutes (P = .02), and complete the primary survey in a timely fashion (P = .05). They required fewer prompts (P = .04) and made fewer mistakes (P = .07).

Conclusions  A structured, formal curriculum can improve the necessary fund of knowledge, skills, confidence, and leadership required for resuscitation.

From the Divisions of Emergency Medicine (Drs Nadel, Lavelle, Fein, Decker, and Durbin) and Child Development and Rehabilitation (Dr Giardino), Department of Pediatrics, and the Children's Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics (Dr Durbin), University of Pennsylvania School of Medicine, Philadelphia.

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