168 - Resident Performance in Mock Codes at a Community Hospital, Pediatrics Department

Publication Number: 4165.168

Carl G. Julien, The Brooklyn Hospital Center, Brooklyn, NY, United States; Ankita Nanda, The Brooklyn Hospital Center, Brooklyn, NY, United States; Noah P. Kondamudi, The Brooklyn, Brooklyn, NY, United States

Background: Pediatric resuscitations are rare, high-acuity events requiring rapid coordination and adherence to Pediatric Advanced Life Support (PALS) guidelines. Simulation-based mock codes offer a safe setting to evaluate performance, yet nearly all published data come from tertiary centers. Evidence from community hospitals is limited.

Objective: To evaluate pediatric resident performance during simulation-based mock codes in a community hospital and identify factors associated with adherence to PALS benchmarks and simulated patient stabilization.

Design/Methods: Mock codes were conducted under the supervision of an attending physician, who also facilitated the debrief session following each event. PGY 2 residents in our program are required to lead a mock code during their PICU rotation. A retrospective observational review of the most recent 15 mock codes (July 2024–October 2025) was conducted. Timeliness, adherence, and teamwork were assessed using standardized PALS checklists and validated instruments—the Team Emergency Assessment Measure (TEAM) and the Ottawa Global Rating Scale (GRS). Descriptive and non-parametric analyses (Spearman ρ, Mann-Whitney U, Fisher’s Exact) evaluated associations between adherence, teamwork, and stabilization outcomes.

Results: Median adherence to PALS benchmarks was 72% (IQR 64–82). Role assignment ≤60 s occurred in 100%, airway assessment within 90 seconds in 87%, bag-mask ventilation within 90 seconds in 13%, and epinephrine administration within 300 seconds in 7%. Only 20% achieved full adherence to all applicable benchmarks. Median TEAM leadership and teamwork scores were 3.1/4 and Ottawa GRS leadership 5.6/7). Higher TEAM (ρ= +0.68) and Ottawa (ρ=+0.61) scores correlated with adherence (p < 0.01). Teams achieving stabilization (60%) demonstrated higher adherence (81% vs 62%, p = 0.04) and stronger leadership/communication scores (p = 0.03–0.04). Though limited by small sample size, trends consistently favored better outcomes with stronger teamwork.

Conclusion(s): Resident-led mock codes in a community hospital showed strong leadership and teamwork but persistent delays in vascular access and medication delivery. Higher teamwork scores were significantly associated with improved adherence and simulated stabilization. Regular, structured, interdisciplinary mock code training with targeted debriefing and role-clarity drills can enhance real-world resuscitation readiness, especially in the community-hospital based residency programs.