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Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 610-619 (doi:10.1542/peds.2008-2658)
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ARTICLE

Reforming Procedural Skills Training for Pediatric Residents: A Randomized, Interventional Trial

Michael G. Gaies, MD, MPHa, Shaine A. Morris, MDb, Janet P. Hafler, EdDc, Dionne A. Graham, PhDd, Andrew J. Capraro, MDe, Jing Zhou, MSd, Christopher P. Landrigan, MD, MPHe,f, Thomas J. Sandora, MD, MPHe,g

a Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, C. S. Mott Children's Hospital, Ann Arbor, Michigan
b Department of Cardiology, Baylor School of Medicine, Texas Children's Hospital, Houston, Texas
c Office of Educational Affairs, Tufts University School of Medicine, Boston, Massachusetts
d Clinical Research Program
e Department of Medicine
g Department of Laboratory Medicine, Children's Hospital Boston, Boston, Massachusetts
f Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

BACKGROUND: Pediatric housestaff are required to learn basic procedural skills and demonstrate competence during training. To our knowledge, an evidenced-based procedural skills curriculum does not exist.

OBJECTIVE: To create, implement, and evaluate a modular procedural skills curriculum for pediatric residents.

METHODS: A randomized, controlled trial was performed. Thirty-eight interns in the Boston Combined Residency Program who began their training in 2005 were enrolled and randomly assigned. Modules were created to teach residents bag-mask ventilation, venipuncture, peripheral intravenous catheter (PIV) insertion, and lumbar puncture skills. The curriculum was administered to participants in the intervention group during intern orientation. Interns in the control group learned procedural skills by usual methods. Subjects were evaluated by using a structured objective assessment on simulators immediately after the intervention and 7 months later. Success in performing live-patient procedures was self-reported by subjects. The primary outcome was successful performance of the procedure on the initial assessment. Secondary outcomes included checklist and knowledge examination scores, live-patient success, and qualitative assessment of the curriculum.

RESULTS: Participants in the intervention group performed PIV placement more successfully than controls (79% vs 35%) and scored significantly higher on the checklist for PIV placement (81% vs 61%) and lumbar puncture (77% vs 68%) at the initial assessment. There were no differences between groups at month 7, and both groups demonstrated declining skills. There were no statistically significant differences in success on live-patient procedures. Those in the intervention group scored significantly higher on knowledge examinations.

CONCLUSIONS: Participants in the intervention group were more successful performing certain simulated procedures than controls when tested immediately after receiving the curriculum but demonstrated declining skills thereafter. Future efforts must emphasize retraining, and residents must have sufficient opportunities to practice skills learned in a formal curriculum.

Key Words: educational intervention • procedural skills • residency education/training • competence

Abbreviations: BMV—bag-mask ventilation • CHB—Children's Hospital Boston • LP—lumbar puncture • PALS—pediatric advanced life support • PIV—peripheral intravenous catheter insertion

Accepted Jan 21, 2009.


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