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

Abstract

Background: 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. Objective of the Innovation: 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). Development Process and Implementation: 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. Outcomes: 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. Conclusion: 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.