402 - Mental rehearsal as a cognitive tool for enhancement of non-technical skills in neonatal resuscitation

Publication Number: 402.5587

Helen Hu, University of Florida College of Medicine, GAINESVILLE, FL, United States; Tina A. Leone, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Kathleen Brennan, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Diana Vargas, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Neonatal resuscitation involves complex clinical scenarios that require technical and non-technical skills. Mental rehearsal (MR) is a technique where individuals think through skills before performing them and improves the performance of technical skills in medical and surgical settings. It has not been studied with respect to non-technical skills used in neonatal resuscitation.

Objective: The primary objective of this study was to examine whether MR affects measures of non-technical skills performance during simulated neonatal resuscitation. Secondary objectives included assessment of NRP technical skills.

Design/Methods: This was a prospective, randomized, controlled trial. Participants included NRP-trained healthcare practitioners (HCP) who were randomized to either control or intervention groups stratified by experience level. All participants completed a baseline simulation (sim1). The intervention group received a standardized script that provided guided visualization of the steps of neonatal resuscitation. The control group reviewed standardized NRP training materials. Both groups were instructed to study the materials for 20 minutes prior to a post-intervention simulation (sim2) that occurred at least 1 week after sim1. Sessions were video recorded for scoring by two independent reviewers masked to study group. Non-technical skills were evaluated using the Anesthetists’ Non-technical Skills (ANTS) tool (scaled score 0 to 4). Technical skills were evaluated using the Neonatal Resuscitation Performance Evaluation (NRPE) tool. A sample size of 32 subjects was required to find a difference of 0.5 in ANTS score from sim1 to sim2 with 80% power and alpha of 0.05.

Results: 35 participants consented, and 31 were randomized to control (n=15) and intervention groups (n=16). Baseline demographics and experience levels were similar between groups (Table). The mean (SD) ANTS score increased from 2.77 (0.66) in sim1 to 3.12 (0.49) in sim2 (p < 0.001). The mean (SD) NRPE score increased from 80.5% (12.2%) in sim1 to 86.6% (7%) in sim2, p=0.009. There were no differences in ANTS and NRPE scores from sim1 to sim2 between randomization groups. The mean (SD) change in ANTS scores from sim1 to sim2 was 0.42 (0.49) for junior clinicians and 0.28 (0.57) for more senior clinicians, p=NS. The mean change in NRPE score was 7.6% (10.8%) for junior clinicians and 2.0% (8.8%) for more senior clinicians.

Conclusion(s): Mental rehearsal did not improve ANTS or NRPE scores over review of NRP materials. Non-technical and technical skills can improve over time with repetition and dedicated review of materials.

Figure: A. Anesthetist's Non-technical Skills (ANTS) scores B. Neonatal Resuscitation PerformanceEvaluation(NRPE) scores
MR_PAS_Figure.pdfcA ANTS stores are assigned on ascale from Oto 4, with higher scores representing better non-technical skills performance. Sim1 control
group mean (5D) 2.68 (0.69), sim1 mental rehearsal (MR) group mean (SD) 2.85 (0.65). Sim2 control group mean (5D| 3.0 (0.47), sim2 MR group mean (5D) 3.2 (0.5).
B: NRPE scores are reported as percentages. Sim1 control group mean (5D] 81.8% (9.3%), sim1 MR group m e a n (SD) 81.9% (10.6%|. Sim2 control group mean (5D) 88.2% (4.4%), sim2 MR group mean (5D] 85.3% (B.756].

Table: Demographics and Clinical Experience
MR_PAS_Table.pdfDemographics and clinical experience of participants. Participants were NRP-trained neonatal-perinatal medicine fellows and advanced practice providers (APP).

Figure: A. Anesthetist's Non-technical Skills (ANTS) scores B. Neonatal Resuscitation PerformanceEvaluation(NRPE) scores
MR_PAS_Figure.pdfcA ANTS stores are assigned on ascale from Oto 4, with higher scores representing better non-technical skills performance. Sim1 control
group mean (5D) 2.68 (0.69), sim1 mental rehearsal (MR) group mean (SD) 2.85 (0.65). Sim2 control group mean (5D| 3.0 (0.47), sim2 MR group mean (5D) 3.2 (0.5).
B: NRPE scores are reported as percentages. Sim1 control group mean (5D] 81.8% (9.3%), sim1 MR group m e a n (SD) 81.9% (10.6%|. Sim2 control group mean (5D) 88.2% (4.4%), sim2 MR group mean (5D] 85.3% (B.756].

Table: Demographics and Clinical Experience
MR_PAS_Table.pdfDemographics and clinical experience of participants. Participants were NRP-trained neonatal-perinatal medicine fellows and advanced practice providers (APP).