Benchmark Performance of Emergency Medicine Residents in Pediatric Resuscitation: Are We Optimizing Pediatric Education for Emergency Medicine Trainees and Does Length of Training Matter?

Pediatric critical resuscitation is a high-acuity, low-occurrence (HALO) event for emergency medicine (EM) providers in the United States (US). Concerns exist regarding preparedness of graduating US EM residents due to limited exposure to critically ill children during training and the variability of current pediatric emergency medicine (PEM) curricula. This study sought to begin the process of benchmarking clinical performance of EM residents leading simulated pediatric resuscitations, to assess the correlation between performance and self-efficacy, and to compare the differences between three- and four-year EM training programs.

This is a prospective, cross-sectional, multicenter simulation-based cohort study (2019–2024) across eight US EM residency programs. The study cohort included graduating EM residents who acted as team leader for three standardized pediatric resuscitation scenarios (septic shock, status epilepticus and cardiac arrest). Simulated resuscitations were video-recorded and scored by three blinded reviewers using validated case-specific checklists. Additionally, prior to simulations, participants completed a 100-point Likert self-efficacy survey adapted from a validated instrument. The primary outcome was a Total Performance Score (TPS), a percent compliance to established guidelines, for the combined performance data. Secondary outcomes included correlation between TPS and self-efficacy, and comparison between 3- vs 4-year programs.

Of the 103 eligible residents, 69 (67%) participated (56% PGY3, 44% PGY4). Performance gaps were consistent across cohorts. In the sepsis case, only 9% delivered the recommended 60 mL/kg IV fluid within 15 minutes, and 9% initiated vasopressors after the third bolus. In the seizure case, 73% checked glucose appropriately and 61% dosed dextrose correctly. In the cardiac arrest case, compression rate was correct in 48%, backboard use in 25%, and correct epinephrine dosing approximated 60%. Overall, mean TPS was 60.5 (±9.8), with no significant difference between 3- and 4-year programs (p = 0.956). Median 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 were noted but did not meet statistical significance.

Graduating US EM residents demonstrated moderate pediatric resuscitation performance with some critical deficits in basic life support, weight-based medication dosing, and septic shock 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.