Board 314 - Research Abstract Simulation as a Tool for Improving Acquisition of Neonatal Resuscitation Skills (Submission #946)

Introduction/Background The first few minutes after birth are most critical for a newborn. Although most infants transition with ease, some require delivery room resuscitation.1 The quality of initial resuscitation may impact the infant’s short- and long-term outcome.2 Traditionally, neonatal providers are present at deliveries as soon as the need is recognized and delivery of the infant is imminent. However, in the event that the neonatal resuscitation team is not present, the obstetric team must initiate resuscitation. While obstetric nurses complete resuscitation training, obstetric physicians are often not required to complete neonatal resuscitation training. In order to fulfill this educational need we hypothesize that a short instructional session that teaches initial neonatal resuscitation steps with a simulation based curriculum will increase obstetric physician confidence, knowledge, performance and retention of neonatal resuscitation skills. Methods This was a prospective randomized, controlled trial of 33 obstetric residents. Subjects received baseline confidence, knowledge and clinical skills assessments. Subjects were then randomized to traditional lecture (n=14) or simulation-based (n=19) neonatal resuscitation education with a focus on initial steps. All instructional sessions were less than one hour in duration and both lecture and simulation interventions contained the same content. The simulation session required that the subject learn how to resuscitate a depressed neonate “hands on” with expert coaching. Follow-up assessments of confidence, knowledge and clinical skills occurred at intervals of three and six months post initial instruction. Confidence was reported based on a Likert scale of 1 (least confident) to 5 (most confident). Knowledge was assessed using seven multiple choice questions at the three intervals. Clinical assessments were performed in a simulated environment and were graded as yes/no if the subject completed individual tasks successfully in the following areas: preparation, initial resuscitation, ventilation, cardiovascular resuscitation. Total knowledge and clinical assessment scores were calculated. Statistical analysis was performed with paired T-tests to test individuals improvement and Student T-test for comparisons between groups. Results For both the lecture and simulation-based groups, confidence increased significantly at three and six months post instruction when compared to baseline (p<0.01). This increase in confidence was sustained as there were no significant differences between confidence at three and six months in both groups. Performance on knowledge assessment questions also improved significantly from baseline at three and six months post instruction for both groups when compared to baseline (p<0.01). Knowledge was maintained as there were no significant differences between knowledge scores at three and six months in both groups. Clinical assessments for the lecture group revealed no significant difference in successfully completed tasks between baseline and three months. However, significant improvement was demonstrated when six month performance was compared to baseline and 3 months (P<0.01). For the simulation group, clinical assessment performance was significantly improved at three and six months versus baseline (p<0.01) and this improvement was sustained with no significant difference between three and six month scores. Although there was an overall improvement in both groups, analysis with Student T-tests demonstrated that simulation performance scores were significantly higher than the lecture group at both three months (19.8 vs. 13.4) (p<0.01) and 6 months (19.1 vs. 17.2) (p<0.05). Conclusion A short, focused curriculum that teaches initial neonatal resuscitation steps via lecture or simulation enhances subject confidence, knowledge and skills. However, education that incorporates simulation is superior to lecture, resulting in more rapid acquisition of clinical skills and sustained improvements in overall clinical performance. Fortunately, an unanticipated depressed neonate is a relatively infrequent event; however, improved ability for obstetric providers to initiate a prompt and effective neonatal resuscitation after a brief simulation intervention, has the potential to greatly impact outcomes for these vulnerable newborns. References 1. Perlman JM, Risser R: Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adolesc Med 1995; 149:20-25. 2. Casalaz DM, Marlow N, Speidel BD: Outcome of resuscitation following unexpected apparent stillbirth. Arch Dis Child Fetal Neonatal Ed 1998;78:F112-F115. Disclosures None.