Traditional Poster Round
Background: Significant neonatal interventions performed by pediatricians in the delivery room are required by approximately 10% of babies. Pediatric residents and program directors report a lack of confidence and competence in a number of aspects of neonatal resuscitation. Simulation-based training is an effective tool for teaching the Neonatal Resuscitation Program (NRP). Just-in-time (JIT) in situ simulations bring the simulation closer in time and space to the event being simulated, but this method of simulation has not been studied for neonatal resuscitation.
Hypothesis: A series of JIT, in-situ simulation-based training sessions will result in a greater improvement in pediatric residents’ performance of neonatal resuscitation compared with our current neonatal resuscitation curriculum.
Methods: A prospective, quasi-randomized, controlled trial of JIT, in-situ simulation-based training sessions compared with our current resident neonatal resuscitation curriculum. Subjects are second year pediatric residents. All subjects participated in a video-taped simulation session scored by video-review at the beginning and at the end of the study and the primary outcome is the change in simulation score for each subject. The intervention group had 2 JIT, in-situ simulation sessions on the days they were responsible for attending deliveries which reviewed the basic objectives of NRP. Control subjects reviewed the same objectives of NRP during a group session at the start of the rotation. We compared the change in scores between the groups to evaluate the effectiveness of JIT. Subjects were asked to complete an online form for each delivery they attended in addition to completing confidence surveys at the beginning and the end of their participation.
Results: Interim survey and delivery data are available for 33 subjects: 16 intervention and 17 controls. Enrollment began in March 2018 and will be complete in December 2018. Video review for assessment of the primary outcome is in progress. Preliminary survey data show self-reported confidence in attending deliveries increased from 21% to 88% for all subjects but this increase was not statistically different between the groups (p= 0.8). Data is available for 57 deliveries during the study. Fourteen babies (25%) required positive pressure ventilation (PPV). The pediatric resident performed the PPV exclusively in 5 (36%) of these cases. Of these 5 cases, 4 were performed by subjects who had simulations earlier the same day. Additionally, compared with subjects who did not have a simulation on the same day as the delivery (41%), subjects who had simulation sessions (72%) more often strongly agreed with the statement “I felt prepared to attend this delivery” (p = 0.02; 95% CI: 5.0 to 51.4).
Discussion: Pediatric residents’ self-reported confidence to attend deliveries increased during this study. JIT in-situ simulations increased feelings of preparedness, but sample size is insufficient to determine whether these simulation sessions significantly affect resident performance in actual deliveries.
I would like to acknowledge the Klaus American Academy of Pediatrics Beth Israel Deaconess Neonatology Foundation Education Research Award for support of this project.