Unmasking a core competency deficit: bag mask ventilation skills of graduating pediatric residents

To determine the percentage of graduating pediatric residents who have achieved competency in providing bag-mask ventilation (BMV) to neonates. To compare competency among residents based on the use of a T-piece resuscitator vs. a flow-inflating bag.

This was a descriptive, prospective cohort study conducted at a large academic children's hospital with third-year, categorical pediatric residents in their final quarter of training. Residents completed a survey and performed two 60-s standardized BMV skills sessions (first using a neonatal T-piece resuscitator and second using a flow-inflating bag) on a high-fidelity manikin with a respiratory function monitor. Competency was defined as tidal volume and respiratory rate in the goal range greater than 75% of the time. Session-specific mean BMV outcomes at the participant level were compared using the Wilcoxon rank sum test and the Chi-square/Fisher's exact test. Comparisons between flow-inflating bag and T-piece resuscitator sessions were done using paired t-test or mixed-effect models.

Twenty-three of the 38 eligible residents (61%) participated. Notably, 48% of residents performed BMV $\le$ 5 times, and only 61% believed their graduating peers were prepared to independently perform BMV in clinical practice (Table 1). Overall, 13% of residents achieved competency with the flow-inflating bag compared to 44% with the T-piece resuscitator (p = 0.03; Table 2).

The majority of pediatric residents did not demonstrate competency in BMV. Future studies should enroll pediatric residents from diverse academic institutions to enhance generalizability and inform the development of broadly applicable procedural curricula. This is essential to ensure residents achieve competency to meet ACGME requirements and provide optimal patient care post-residency.

The majority of graduating pediatric residents in this study did not achieve bag-mask ventilation competency when skills were evaluated with a respiratory function monitor. Residents are significantly less likely to achieve competency with the flow-inflating bag as compared to the T-piece resuscitator. This study is an important needs assessment to inform the development of broadly applicable procedural curricula to ensure residents achieve BMV competency.