Mastering Pediatric Airway Skills: A Procedural Simulation Using Rapid Cycle Deliberate Practice for Emergency...

Pediatric emergency medicine (PEM) training within emergency medicine (EM) residency programs varies widely in preceptor expertise, critical care exposure, and procedural opportunities. Despite the importance of pediatric airway management, real-world exposure to critically ill children remains limited and inconsistent across training sites. Current ACGME guidelines provide minimal direction on pediatric-specific content or mandatory procedures, leaving gaps in emergent airway training.

To address perceived deficiencies in pediatric airway skills among EM residents, we implemented a longitudinal, simulation-based pediatric airway curriculum. The primary goal was to improve pediatric airway knowledge, confidence, procedural competency in airway equipment setup, bag-valve-mask (BVM) ventilation, troubleshooting, intubation techniques using a flipped classroom model, and rapid cycle deliberate practice (RCDP).

Guided by Kern's curriculum design framework and selected components of Sawyer's six-step procedural learning model, the curriculum incorporated asynchronous learning and eight interactive simulation sessions over a 12-month period. 40 residents in four postgraduate years participated in two individualized RCDP sessions annually, supported by faculty trained in pediatric airway management. A novel checklist was used for objective performance assessment.

Thirty-one residents completed baseline and post-intervention procedural assessments. Significant improvements were observed in equipment setup and intubation steps (p < 0.05), with first-pass intubation time reduced from 9 min and 12 s to 7 min and 9 s (p < 0.05). Self-reported confidence in pediatric airway management increased across all PGY levels (p < 0.05), and knowledge scores improved (7.8 vs. 9.7, p < 0.05). Resident feedback strongly endorsed the curriculum's value in building skills and confidence.

A structured, simulation-based pediatric airway curriculum using RCDP effectively enhances EM residents' procedural performance and confidence. This model offers a scalable approach for addressing critical skill gaps in PEM training. Future directions include integrating advanced airway techniques and longitudinal retention assessments.