Assessing pediatric residents' clinical performance in procedural sedation: a simulation-based needs assessment.

Area of Science:

• Pediatric Emergency Medicine
• Medical Education
• Clinical Simulation

Background:

• Procedural sedation (PS) is a common practice in pediatrics.
• Assessing resident competency in PS is crucial for patient safety.
• Gaps in training may exist regarding preparation, adverse event management, and confidence levels.

Purpose of the Study:

• To assess pediatric residents' clinical performance during simulated procedural sedation (PS).
• To evaluate residents' reported experience and confidence with PS.
• To identify educational needs in PS training for pediatric residents.

Main Methods:

• Prospective observational cohort study involving pediatric residents.
• Survey assessing confidence in PS using Likert-scaled items.
• Standardized, video-recorded simulated PS with adverse events (apnea, desaturation).
• Performance evaluation using an expert consensus-derived checklist.
• Statistical analysis of confidence scores by postgraduate year (PGY) and descriptive quantification of checklist items.

Main Results:

• 35 PGY-1, 39 PGY-2, and 7 PGY-3 residents participated.
• High completion rates for monitoring and oxygen administration during adverse events.
• Low completion rates for preparation tasks (shoulder roll availability, head-of-bed access) and calling for help.
• Median time to adverse event recognition: 33 seconds; oxygen delivery: 60 seconds; positive pressure ventilation (PPV): 97 seconds.
• Confidence scores significantly increased with PGY level (ANOVA P<0.0001).

Conclusions:

• Significant differences in confidence and performance exist across PGY levels.
• Observed performance highlights educational gaps in pediatric resident PS training.
• Curriculum development should emphasize PS preparation, equipment, and adverse event interventions.