What was known Pediatrics residents need to acquire cardiopulmonary resuscitation (CPR) skills, yet opportunities in day-to-day practice are scarce.;What is new Simulation-based training measured time efficiency gains in 3 critical actions in CPR.;Limitations Single-site, single-specialty study may limit generalizability. Potential exists for bias in the assignment to the study versus control group. Assessment was focused on time to initiation, not quality of execution of the skills.;Bottom line Simulation training resulted in time efficiency gains in initiating key components of CPR in first-year pediatrics residents.;Editor's Note: The online version of this article contains instructional content, the baseline skills survey, and the experience survey used in this study.;Introduction Pediatric cardiopulmonary arrest is a rare event, and timely, high-quality cardiopulmonary resuscitation (CPR) improves outcomes.1–4 Pediatrics residents have a critical role in initiating life-saving interventions yet have little opportunity to develop or maintain their resuscitation skills.5–7 The timely delivery of high-quality CPR is a key dimension of good care, and delays in initiating CPR have a detrimental effect on patient outcome regardless of the quality of resuscitation.8–12 Pediatrics residents have demonstrated good knowledge of CPR and pediatric advanced life support (PALS), as reflected by high scores on written tests. At the same time, many residents show suboptimal clinical skills in mock code performance.7,13 The paucity of opportunity to practice these skills makes the application to actual patient care challenging. Simulation-based training has demonstrated effectiveness in promoting skill acquisition.14–26 There is growing research in pediatrics evaluating the effect of simulation-based training on the clinical performance of PALS skills during resuscitations.13,20,22,27–31 Most practicing primary care pediatricians or clinic-based subspecialists are unlikely to perform CPR frequently, and residency training should prepare the pediatrician to appropriately initiate CPR until help arrives. Our study uses standardized simulations to assess first-year pediatrics residents in 3 critical actions of CPR: (1) calling for help, (2) initiation of bag-mask ventilation (BMV), and (3) initiation of chest compressions. Our hypothesis was that a simulation-based educational intervention will reduce residents' time to initiation of CPR.;Results At baseline, there were no significant differences between the groups in medical school and clinical experience, previous simulation training, and participation in mock codes. There also were no significant differences between the groups at all 3 evaluation periods regarding their experience hearing or reading about resuscitation skills. There were some differences between the groups reported in observing and participating in resuscitation skills at the 3- and 6-month evaluations (table 2). View larger version (22K) TABLE 2Comparison of Clinical Experience Between Early- and Late-Intervention Groups;Discussion Our study demonstrates the efficacy of simulation training in reducing time to initiation of CPR for first-year pediatrics residents. Using an objective time-based measure to evaluate individual resident's performance with a late-intervention group to control for clinical experience allowed us to evaluate the impact of our educational intervention. An important finding was the reduction in time to initiation of chest compressions. At baseline, most residents took more than 2?minutes to initiate chest compressions in a pulseless patient, and 25% never initiated compressions. This finding is similar to those in a study of pediatrics residents participating in mock codes in which 66% failed to start compressions within 1?minute of pulselessness, and 33% never started compressions.6 Our study demonstrated that the early-intervention group significantly reduced the time to initiation of compression
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