Rapid cycle deliberate practice to improve airway skills and performance of trainees in a pediatric emergency department

Katherine J Edmunds; Ashish Shah; Gary L Geis; Benjamin T Kerrey; Gina Klein; Rebecca DeBra; Yin Zhang; Karen Ahaus; Stephanie Boyd; Phillip Thomas; Preston Dean

doi:10.1002/aet2.10928

Rapid cycle deliberate practice to improve airway skills and performance of trainees in a pediatric emergency department

AEM Educ Train. 2024 Jan 16;8(1):10.1002/aet2.10928. doi: 10.1002/aet2.10928. eCollection 2024 Feb.

Authors

Katherine J Edmunds^{1

2}, Ashish Shah³, Gary L Geis^{1

2

4}, Benjamin T Kerrey^{1

2}, Gina Klein⁴, Rebecca DeBra⁴, Yin Zhang⁵, Karen Ahaus¹, Stephanie Boyd¹, Phillip Thomas¹, Preston Dean^{1

2}

Affiliations

¹ Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.
² Department of Pediatrics University of Cincinnati, College of Medicine Cincinnati Ohio USA.
³ Division of Emergency Medicine, Rady Children's Hospital University of California San Diego San Diego California USA.
⁴ The Center for Simulation and Research Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.
⁵ Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.

PMID: 38235393
PMCID: PMC10790190 (available on 2025-01-16)
DOI: 10.1002/aet2.10928

Abstract

Objective: The study objective was to determine the effect of a rapid cycle deliberate practice (RCDP) program on simulated and actual airway skills by pediatric emergency medicine (PEM) fellows.

Methods: We designed and implemented a 12-month RCDP airway skills curriculum for PEM fellows at an academic pediatric institution. The curriculum was designed using airway training literature, RCDP principals, and internal quality assurance airway video review program. Simulation training scenarios increased in complexity throughout the curriculum. PEM fellows participated in monthly sessions. Two PEM faculty facilitated the sessions, utilizing a step-by-step objective structured clinical evaluation (OSCE)-style tool for each scenario. Data were collected for all four levels of the Kirkpatrick Model of Training Evaluation-participant response (reaction, pre-post session survey), skills performance in the simulation setting (learning, pre-post OSCE), skills performance for actual patients (behavior, video review), and patient outcomes (results, video review).

Results: During the study period (August 2021 to June 2022), 13 PEM fellows participated in 112 sessions (mean nine sessions per fellow). PEM fellows reported improved comfort in all domains of airway management, including intubation performance. Participant OSCE scores improved posttraining (pretraining median score for trainees 57 [IQR 57-59], posttraining median 61 [IQR 61-62], p = 0.0005). Over the 12 months, PEM fellows performed 45 intubation attempts in the pediatric emergency department (median patient age 4 years [IQR 1-9 years]). Compared to a 5-year historical cohort, participants had higher first-pass success (87% vs. 71%, p = 0.028) and shorter attempt duration (22 s vs. 29 s, p = 0.018). There was no significant difference in the frequency of oxyhemoglobin desaturation in the training period versus the historical period (7% vs. 15%, p = 0.231).

Conclusions: At multiple levels of educational outcomes, including participant behavior and patient outcomes, an RCDP program was associated with improved airway skills and performance of PEM fellows.