Initiation of a pediatric mock code program at a children's hospital

Abstract

Background: Pediatric cardiopulmonary arrests are rare. Mock codes were instituted to bridge the gap between opportunity and reality. Aim: The goal was to improve medical caregivers' skills in pediatric resuscitation. Methods: All pediatric and internal medicine/pediatric (med/peds) residents were anonymously surveyed pre-and postintervention about confidence level about codes and code skills. Twenty mock codes were conducted during the 1 year intervention period. Statistical comparisons were made between each resident pre-and post-survey, graduating third-year residents (PGY3s) prior to intervention versus PGY3s with mock codes and pediatric versus med/peds residents. Results: All residents significantly improved in their perception of overall skill level during the study ( p < 0.0001). PGY3s were significantly more confident in their skills than PGY2s or PGY1s and PGY2s were significantly more confident than PGY1s both pre-and post-mock codes ( p < 0.0001). Med/peds residents were significantly more confident in their skills than pediatric residents both pre-( p ¼ 0.041) and post-intervention ( p ¼ 0.016). The two skills with the lowest score post-intervention were the ability to place an interosseous line and the ability to manage cardiac dysrhythmias. Conclusions: Pediatric mock codes can improve resident confidence and self-assessment of their resuscitation skills. Data from surveys such as this can be used to design future skill-based educational initiatives.

Pediatric Intensive Care Simulation Course: A New Paradigm in Teaching

“…Although IO placement is discussed in all PALS courses and is considered easy to learn, we found our residents were not confident with this important procedure. 11 Gaies et al 12 found similar findings when surveying pediatric program directors. More than 60% of program directors felt IO placement was a very important skill, but just over 20% felt their graduating residents were competent to perform IO placement.…”

“…8-10 However, we 11 have reported that even bimonthly in situ mock codes did not lead to individual resident learning; instead they highlighted system problems. Based on these results, our current study sought to improve individual resident confidence and performance in managing pediatric code events and performing procedures on critically ill patients.…”

“…Our previously published survey 11 that was used in this study was developed from work by Cappelle and Paul. 10 The 2-part survey is scored on a 5-point Likert scale.…”

“…11 The skill index assessed performance of tasks regarded to be mandatory by the ACGME Pediatric Program Requirements as well as important for PALS certification. 22 These factors add to the content validity of these indexes.…”

“…Based on these results, our current study sought to improve individual resident confidence and performance in managing pediatric code events and performing procedures on critically ill patients. Our course emphasized IO placement, an important procedure in the PICU, 11,12 and one in which our residents perceived themselves to be deficient. We hypothesized that confidence levels with code skills, especially IO placement, intubation skills, and ability to supervise a code would improve after exposure to a simulator-based PICU training course.…”