Abstract P70: Does Teaching Crisis Resource Management Skills Improve Resuscitation Performance and Retention in Pediatric Residents?
Objectives: The primary objective was to determine if teaching crisis resource management (CRM) skills to junior pediatric residents improved their medical resuscitation skills during a simulated code. The secondary objective was to determine if CRM instruction improved retention of resuscitation and CRM skills.
Methods: 16 junior pediatric residents at the University of Alberta volunteered to be randomized into 2 matched groups: an intervention group with CRM instruction, and a control group without. Each resident directed standardized resuscitation teams during 2 simulated standardized pediatric code scenarios immediately after the intervention (initial) and 3 months later. The scenarios were videotaped and rated by trained observers, blinded to group and time period, on time to predetermined critical medical interventions and CRM skills (Ottawa Global Rating Scale (OGRS)).
Results: There were no statistical differences in time to critical medical interventions between the control and CRM group in the scenarios immediately following intervention. After 3 months, the CRM group had significantly shorter times for the initial steps of emergent care (application of monitors and oxygen) (p=0.05). There was no significant difference between the 2 groups in time to complete pediatric advanced life support interventions. OGRS scores were higher in the CRM group compared to control group (4.5±1.1 (SE) vs. 3.3±1.1 respectively; p<0.001) which was maintained 3 months later (4.4±1.2 vs. 3.3±1.1). Control group OGRS did not improve over 3 months of traditional residency instruction (initial 3.3±1.1 vs 3.3±1.1). At the 3 month assessment, there was a trend to faster initiation of CPR in the CRM group (CRM 26.8±19.3s vs. 59.4±76s; p=0.1 beta=0.8). The CRM group became faster at starting CPR (26.8±19.3s vs 40.5±3.9s initial) while the control group became slower at starting CPR after 3 months (59.4±76.2 vs 36.0±32.2s initial). The CRM group consistently performed fewer critical medical errors in all scenarios. Conclusions: CRM instruction for pediatric residents in this pilot study demonstrates improvement and retention in CRM and initial emergent care skills during simulated pediatric codes. A study with greater power is warranted.