Traditional Poster Round
Background: : Completion of NRP courses and NICU rotations during a training program has not been shown to prepare pediatric residents to ‘lead’ neonatal resuscitation teams adequately. Simulation can be used as an adjunct tool to consolidate teamwork skills, and develop leadership potential. In reality, many learners end up observing rather than participating in simulation due to logistics and time constraints of current NRP courses. We aimed to evaluate if being an observer versus actually participating in a simulation training session influenced performance in subsequent simulated neonatal resuscitation events.
Research Question: : Primary Objective: We compared the relative effectiveness of learning by Observation vs. Participation in simulation-based neonatal training session in subsequent neonatal resuscitation, both in technical and non-technical skills. Secondary Objectives: (i) We compared the changes in stress measures between participants and observers, (ii) if differences in stress during simulated neonatal resuscitation were associated with enhanced subsequent performance.
Methodology: : True experiment design (Pre-test, Post-test, with an intervention group) was used in the study. Institutional REB approval was obtained. Senior pediatric trainees from the pediatrics and neonatal programmes were invited to participate. Confederates used in neonatal training included a set nurse and respiratory therapist. Training scenarios were designed for high fidelity, standardized and conducted within a simulation center . All trainees took part in a simulated resuscitation as a 'pre-test'; each led the resuscitation in a simulated NRP scenario, followed by didactic teaching emphasizing teamwork and leadership. Participants performed 3 subsequent simulated neonatal resuscitations, while observers watched via closed-circuit television in the next room. Both groups were video-debriefed together using standardized PeARLS methodology. Retention tests were performed 6-8 weeks later. Both pre-and post-simulated resuscitations were video-taped for later review by 2 independent evaluators using validated assessment tools. Salivary cortisol levels (objective stress indicator) were collected from trainees of both groups at specific time points. Trainees self reported their perceived levels of anxiety/stress (subjective stress indicator) answering a previously validated questionnaire (State-Trait Anxiety (STAI).
Results: : 22 pediatric trainees were randomized into a participant (n=11) or an observer group (n=11). There were no differences in clinical experience between these groups, baseline stress levels, or time since their last NRP course. The median time between resuscitation training and retention was 7.6 weeks (+/- 2.4 wks). Both groups improved their NRP performance (technical skills and non-technical skills) but there was no difference in overall performance. Both participants and observers experienced increased levels of stress during the simulated training .
Discussion/Conclusions: : Simulated neonatal resuscitation training was associated with improved skills in learners regardless of whether they participated or observed. Limitations included a small sample-size which may have masked an actual difference and difficulty to control for actual resuscitations learners participated in during the interval training time. Caution needs to be interpreted when planning NRP sessions since transferability of skills acquired from a simulated-setting to clinical setting was not being studied.