Using pediatric advanced life support in pediatric residency training: Does the curriculum need resuscitation?

Objective: The Pediatric Advanced Life Support (PALS) course is used throughout North American pediatric residency programs to provide a core pediatric resuscitation curriculum. Despite this widespread use, its effectiveness has not been formally assessed in pediatric residents. This study aimed to evaluate the PALS curriculum's effectiveness in providing pediatric residents with knowledge, skill and confidence in pediatric resuscitation. Design: Course evaluation. Setting: Tertiary care pediatric hospital. Subjects: Pediatric residents. Interventions: Subjects were followed prospectively for 1 yr following completion of an annual PALS course. Multiple choice and short answer questionnaires were used to evaluate residents' knowledge immediately before and after completion of the course and throughout the following year. Confidence in ten aspects of pediatric resuscitation was assessed. Scores were compared before and after the PALS course to evaluate acquisition of knowledge and confidence. Scores at 12 months were compared with the immediate post-PALS course scores to evaluate maintenance of knowledge and confidence over time. Technical skills were evaluated by staff anesthetists using a 3-point scale. Measurements and Main Results: Knowledge questionnaire scores were significantly higher post-PALS compared with pre-PALS, but knowledge of the details of PALS algorithms decreased significantly over the following 12 months. Confidence ratings improved post-PALS on only two of ten measures and remained very low overall. Residents could complete the four core technical skills but required assistance or multiple attempts. Conclusions: PALS is successful in providing basic resuscitation knowledge to pediatric residents, but knowledge of critical algorithm details is not sustained. The course does not provide for the expected level of competency in relevant technical skills. Residents do not achieve the confidence to feel well prepared to provide comprehensive care to pediatric patients in cardiopulmonary arrest. These findings support the hypothesis that the PALS course alone is insufficient to provide pediatric residents with competency in cardiopulmonary resuscitation.