Association between time since advanced life support training and crisis resource management performance in pediatric healthcare providers: a simulation-based study

Crisis Resource Management (CRM) skills are essential for effective pediatric resuscitation, yet little is known about how CRM performance varies according to time elapsed since Advanced Life Support (ALS) training, particularly in low- and middle-income countries. This study evaluated CRM performance in relation to time since ALS training. In this prospective cross-sectional, simulation-based observational study conducted at a quaternary care center in India, 99 ALS-certified participants (86 residents, 13 nurses) were stratified into Group A (< 6 months since ALS, n = 42) and Group B (> 12 months, n = 57). Participants managed high-fidelity pediatric cardiac arrest scenarios (VT, VF, SVT). Video recordings were independently assessed using validated tools: the Anaesthetists’ Non-Technical Skills (ANTS) framework for team leaders and the Mayo High Performance Teamwork Scale (MHPTS) for team members. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC). Baseline characteristics differed, with Group B participants being older and having greater prior resuscitation experience ( p ≤ 0.01). Team leader performance (ANTS) showed no significant differences between groups. Key behaviours were infrequently demonstrated, including team member introduction (35.7% vs. 15.7%, p = 0.18) and role assignment (50% vs. 36.8%, p = 0.45). Team member performance (MHPTS) was largely comparable; however, on univariate analysis, Group A demonstrated slightly better role clarity (74.1% vs. 46.1%, p = 0.04) and clearer communication (77.7% vs. 48.7%, p = 0.02). Other domains, including closed-loop communication and checklist use, showed no significant differences. Inter-rater reliability was high (ANTS ICC 0.83; MHPTS ICC 0.79). Pediatric healthcare providers demonstrated suboptimal CRM skills during simulated resuscitation, with no significant differences according to time since ALS training. These findings highlight limitations in the acquisition of non-technical skills following standard ALS training. Structured, simulation-based reinforcement strategies may support sustained development of CRM competencies in LMIC settings.