185 - Improving Pediatric Residents’ Intubation Competency Through Simulation-Based Training: A Quality Improvement Initiative

Publication Number: 3178.185

Roy Ghanem, University of Kansas School of Medicine, Wichita, KS, United States; Lukas Hall, WCGME, Wichita, KS, United States; Christopher Plymire, Wesley Medical Center, Wichita, KS, United States; Harsh Nathani, Wesley Medical Center, Wichita, KS, United States; Sara K. Powell, University of Kansas School of Medicine, Wichita, KS, United States; Anton Rogachov, University of Kansas - Wichita, Bel Aire, KS, United States; Robert Steele, University of Kansas School of Medicine, Wichita, KS, United States; Michael T. Nelson, University of Kansas School of Medicine, Wichita, KS, United States; Jacob Hunter, University of Kansas School of Medicine, Wichita, KS, United States; Xinyu Zhang, KUMC, Wichita, KS, United States; William L. Krogman, University of Kansas School of Medicine, Wichita, KS, United States; Nicolas Najm, University of Kansas School of Medicine Wichita, Wichita, KS, United States; Carolyn Ahlers-Schmidt, KUSM-W CRIBS, Wichita, KS, United States

Background: Endotracheal intubation is a critical intervention in pediatric emergency medicine, yet many residents report low confidence and limited procedural exposure. Simulation-based training provides a safe, structured environment to bridge this gap.

Objective: This quality improvement (QI) initiative aims to enhance the skills of pediatric and med-peds residents in intubation through a structured simulation-based training program in partnership with the Department of Anesthesiology.

Design/Methods: This project involved 24 residents from the University of Kansas Medical Center, including pediatric and med-peds participants. Tasks, including literature review and data collection and analysis, were distributed among team members. The IRB designated this project as QI. Stage 1 comprised a seminar led by anesthesiology residents, followed by a hands-on workshop with four stations: bag-mask ventilation (BMV), oro/nasopharyngeal airway and laryngeal mask airway (LMA) insertion, and intubation on infant and adult mannequins. Evaluations included a pre- and post-intervention multiple-choice test (MCQ) and confidence survey, along with a workshop in which anesthesiology faculty formally assessed residents’ knowledge and skills across various aspects of airway management. Primary outcomes measured were changes in confidence levels and intubation competency scores.

Results: In the pre-MCQ, residents scored an average of 11.75 (±3.2) out of 20, indicating foundational knowledge of intubation techniques. After the seminar and workshop, post-MCQ scores rose to 16.4 (±2.8), showing improved knowledge (p < 0.001). Workshop evaluations revealed lower scores for the LEMON assessment (3.588), head positioning (3.706), and bag-masking skills (3.765) on a 4-point scale. Confidence in managing pediatric airways increased from 3.6 (±2.1) to 7.2 (±1.5) post-intervention (p < 0.001). Residents reported feeling significantly more confident performing BMV, with scores increasing from 5.7 ± 2.3 to 8.5 ± 1.7 (p < 0.01). Resident confidence in intubation increased from 3.5 (±1.9) to 7.0 (±1.4) (p < 0.001).

Conclusion(s): Stage 1 of this QI initiative, developed collaboratively with Anesthesiology, effectively improved knowledge and confidence in intubation techniques among pediatric and med-peds residents. Gains in competency indicate that this approach may enhance pediatric airway management training, in the short-term. Longitudinal retention of skills will be assessed via a retention MCQ test after a high-intensity simulation in Spring 2026 (Stage 2).

Mean MCQ scores Before and After Airway Seminar and Workshop
Figure 1.pdf

Resident Self-reported Confidence Levels in Intubation Before and After Seminar and Workshop
Figure 2.pdf

Resident Self-reported Confidence Levels in Bag-Mask Ventilation Before and After Seminar and Workshop
Figure 3.pdf