Benchmark Performance of Emergency Medicine Residents in Pediatric Resuscitation: Are We Optimizing Education and...

Pediatric critical resuscitations are high-acuity, low-occurrence events for emergency medicine (EM) providers in the United States (US). Concerns exist regarding graduating US EM resident preparedness due to limited exposure to critically ill children and variability of pediatric EM (PEM) curricula. This study sought to benchmark EM resident performance during simulated pediatric resuscitations, correlate performance and self-efficacy, and compare differences between three- and four-year EM residencies.

This was a prospective, cross-sectional, cohort study (2019-2024) across eight US EM residencies. Participants were graduating residents leading pediatric resuscitation simulations (septic shock, status epilepticus, and cardiac arrest) and completed a self-efficacy survey before participating. Simulations were scored using case-specific checklists. Primary outcome was Total Performance Score (TPS), percent compliance with established guidelines, for combined performance data. Secondary outcomes included the correlation between TPS and self-efficacy and the comparison between 3- and 4-year programs.

Of 103 eligible residents, 69 (67%) participated (56% PGY3, 44% PGY4). Performance gaps were consistent across cohorts. For the sepsis case, 9% delivered 60 mL/kg fluid within 15 min, and 9% initiated vasopressors afterward. For the seizure case, 73% checked glucose appropriately and 61% dosed dextrose correctly. For cardiac arrest, the compression rate was correct in 48%, a backboard was used in 25%, and correct epinephrine dosing approximated 60% of simulations. Mean TPS was 60.5 (±9.8), with no difference between 3- and 4-year programs (p = 0.956). Self-efficacy scores reflected moderate confidence, with 3-year residents reporting higher confidence in trauma (p = 0.031) and respiratory failure (p = 0.008). Correlations between self-efficacy and performance did not meet statistical significance.

Graduating US EM residents demonstrated moderate pediatric resuscitation performance with critical deficits in basic life support, medication dosing, and hemodynamic management. Program length did not impact outcomes. Findings underscore the need for structured, simulation-based PEM curricula to improve pediatric education during EM training.