TY - JOUR
T1 - Assessing pediatric residents' clinical performance in procedural sedation
T2 - A simulation-based needs assessment
AU - Schinasi, Dana Aronson
AU - Nadel, Frances M.
AU - Hales, Roberta
AU - Boswinkel, Jan P.
AU - Donoghue, Aaron J.
PY - 2013/4
Y1 - 2013/4
N2 - OBJECTIVES: Our primary objective in this study was to perform a needs assessment of clinical performance during simulated procedural sedation (PS) by pediatric residents. Our secondary objective was to describe reported experience and confidence with PS during pediatric residency. METHODS: In this prospective observational cohort study, pediatric residents completed a survey of 15 Likert-scaled items pertaining to confidence in PS, followed by performance of a standardized, video-recorded simulated PS complicated by an adverse event (AE): apnea and desaturation. Clinical performance was evaluated according to an expert consensus-derived checklist of critical tasks. The difference in reported confidence between postgraduate years (PGY) was assessed by one-way analysis of variance (ANOVA); clinical checklist items were quantified descriptively. RESULTS: A total of 35 PGY-1, 39 PGY-2, and 7 PGY-3 residents participated. The most frequently completed tasks by all residents are ensuring the cardiorespiratory monitor (73%) and connecting the oxygen tubing (70%) during the preparation phase and recognizing AE (97%) and administering oxygen (95%) during the AE phase. Tasks that were completed infrequently by all residents include ensuring that the shoulder roll is available (11%) and ensuring access to head-of-bed (31%) during the preparation phase and applying shoulder roll (10%) and calling for help (23%) during the AE phase. The median time to recognition of AE from onset of hypoventilation was 33 seconds and that for delivery of oxygen and PPV was 60 and 97 seconds, respectively. Median confidence scores increased by PGY (PGY-1, 2; PGY-2, 3; PGY-3, 4; ANOVA F2,82 = 75, P< 0.0001). CONCLUSIONS: Significant differences exist in the reported confidence and observed performance among PGY levels during simulated PS. Resident performance on this checklist demonstrates educational needs in PS training. A curriculum in PS for pediatric residents should focus on reviewing preparation steps, equipment, and potential interventions should an AE occur.
AB - OBJECTIVES: Our primary objective in this study was to perform a needs assessment of clinical performance during simulated procedural sedation (PS) by pediatric residents. Our secondary objective was to describe reported experience and confidence with PS during pediatric residency. METHODS: In this prospective observational cohort study, pediatric residents completed a survey of 15 Likert-scaled items pertaining to confidence in PS, followed by performance of a standardized, video-recorded simulated PS complicated by an adverse event (AE): apnea and desaturation. Clinical performance was evaluated according to an expert consensus-derived checklist of critical tasks. The difference in reported confidence between postgraduate years (PGY) was assessed by one-way analysis of variance (ANOVA); clinical checklist items were quantified descriptively. RESULTS: A total of 35 PGY-1, 39 PGY-2, and 7 PGY-3 residents participated. The most frequently completed tasks by all residents are ensuring the cardiorespiratory monitor (73%) and connecting the oxygen tubing (70%) during the preparation phase and recognizing AE (97%) and administering oxygen (95%) during the AE phase. Tasks that were completed infrequently by all residents include ensuring that the shoulder roll is available (11%) and ensuring access to head-of-bed (31%) during the preparation phase and applying shoulder roll (10%) and calling for help (23%) during the AE phase. The median time to recognition of AE from onset of hypoventilation was 33 seconds and that for delivery of oxygen and PPV was 60 and 97 seconds, respectively. Median confidence scores increased by PGY (PGY-1, 2; PGY-2, 3; PGY-3, 4; ANOVA F2,82 = 75, P< 0.0001). CONCLUSIONS: Significant differences exist in the reported confidence and observed performance among PGY levels during simulated PS. Resident performance on this checklist demonstrates educational needs in PS training. A curriculum in PS for pediatric residents should focus on reviewing preparation steps, equipment, and potential interventions should an AE occur.
KW - curriculum development
KW - procedural sedation
KW - resident education
KW - simulation
UR - http://www.scopus.com/inward/record.url?scp=84876413588&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876413588&partnerID=8YFLogxK
U2 - 10.1097/PEC.0b013e31828b6552
DO - 10.1097/PEC.0b013e31828b6552
M3 - Article
C2 - 23528514
AN - SCOPUS:84876413588
SN - 0749-5161
VL - 29
SP - 447
EP - 452
JO - Pediatric emergency care
JF - Pediatric emergency care
IS - 4
ER -