199 - Acquisition to Retention: Improving Resident Neonatal Resuscitation via Deliberate Simulation-Based Training and Module Teaching

Publication Number: 199.3844

Julia Mathew, Cohen Children's Medical Center, Manhasset, NY, United States; Krista LoRe, Cohen Children's Medical Center, Port Washington, NY, United States; Naomi S. Cohen, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States; Grace Liao, Cohen Children's Medical Center, New York, NY, United States; Jonathan Sasenick, Cohen Children's Medical Center, Massapequa, NY, United States; Stephanie Galanti, Cohen Children's Medical Center, New Hyde Park, NY, United States; Stephanie C. Ryals, Emory University School of Medicine, Atlanta, GA, United States

Background: Pediatric residents are Neonatal Resuscitation Program (NRP) certified and serve as frontline providers for newborns at deliveries in our institution. Months can pass between initial NRP certification and nursery service without retraining. Annual resident evaluation of the nursery rotation indicated demand for additional NRP education, thus serving as our needs assessment. Previous studies also note skill decay over time without targeted reinforcement.

Objective: We implemented an educational curriculum for first-year residents targeting key steps of resuscitation as defined by NRP to improve trainee proficiency as providers at deliveries.

Design/Methods: The curriculum included three targeted learning modules: (1) an overview of the NRP algorithm, (2) equipment selection and code medication dosing, and (3) preparation of the radiant warmer. Assessments of each resident were made prior to the curriculum (“baseline”), after completing the curriculum (“acquisition”), and at the end of the academic year (“retention”) (Figure 1). Each assessment consisted of a scored delivery room simulation and a multiple-choice test based on NRP. Time to initiation of positive pressure ventilation (PPV) is a key element of neonatal resuscitation, NRP recommending that PPV begin within 60 seconds of life for the distressed neonate. This key performance indicator was tracked for each simulation. At completion of each simulation, the residents were asked to select the doses of potential code medications for the given scenario. Rising second-year residents who did not receive the curriculum were assessed to establish a control group.

Results: Thirty-three first-year residents enrolled in the curriculum, with sixteen completing it. On the simulation portion of the assessments, participants scored an average of 62% at baseline, 85% at acquisition, and 92% at retention. Time to PPV improved from an average of 76.6 seconds at baseline, to 45.3 seconds at acquisition, and 54.4 seconds at retention. In comparison, the control group scored an average of 66% on the retention simulation, with a mean time to PPV of 55.8 seconds. Note, for the experimental group, knowledge of code medication dosing improved from 38% at baseline, to 99% at acquisition, and to 76% at retention. In comparison, the control group scored an average of 33% (Figure 2).

Conclusion(s): Without interim retraining, study participants’ performance was superior immediately post-curriculum and at conclusion of the academic year compared to the control group. These data support the implementation of a targeted NRP curriculum for trainees to improve proficiency.

Figure 1. Curriculum Overview


Figure 2. Simulation and Code Dosing Knowledge Scores