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A binary logistic regression model was used for the primary outcome, and binomial logistic regression models were used for the secondary outcomes. Finally, interrater reliability was assessed using Fleiss��s Kappa for the binary outcome of pass/fail. Intraclass correlation coefficient PD98059 was used to assess interrater reliability for each of the secondary outcomes. A P-valueDecitabine Review Board (#13E-775950) and the Universidad Nacional Aut��noma de Nicaragua (UNAN) Le��n Bioethics Committee (Acta #92). Results On the CASTest, there are 19 specific critical actions that the resident must achieve to obtain a passing score. ��Achievement�� of the action is defined as obtaining a rating of borderline, acceptable, or excellent on that action, i.e. they cannot be given the rating ��not achieved��. On the pre-course simulation exam, only 1 out of 13 subjects (7.7%) passed the test. Immediately post-course, the subjects achieved 4 out of 13 subjects (30.8%) passed, and 6 months after the course, the pass rate was 46.2% (6/13) (Table 2). Table 2. Comparison of outcomes at pre-test, post-test, and 6 months after post-test of 13 Nicaraguan resident physicians who participated in 2014 Project Tryptophan synthase Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) resuscitation course For the primary outcome of passing the CASTest exam, after the course, the participants were significantly more likely to pass the CASTest when accounting for evaluator and subject effects in a logistic regression model (OR=13.1, 95% CI 2.5-68.5). Furthermore, subjects maintained their improved ability to pass the CASTest at 6 months after the course. (OR= 21.7, 95% CI 4.2-112.8) (Table 3). There was no significant difference in the passing scores at 6 months as compared to immediately post course, signifying very little decay in acquired skills (OR 1.65, 95% CI 0.61-4.48).