GROWTH MINDSET MODERATES THE IMPACT OF NEONATAL RESUSCITATION SKILL MAINTENANCE ON PERFORMANCE IN A SIMULATION TRAINING VIDEO GAME
Authors: Cutumisu Maria , Brown Matthew , Frayr Caroline , Schmolzer Georg 
Published: May 2018

Abstract

BACKGROUND
The Joint Commission on Accreditation of Healthcare Organizations (2004) reporting on preventing infant death and injury during delivery identified human errors during neonatal resuscitation as responsible for more than two thirds of perinatal mortality and morbidity. One of the main causes of human error in neonatal resuscitation stems from a lack of practical learning experiences highlighted by the neonatal training paradox of high-acuity, low-occurrence (HALO) situations that arise infrequently. simulation-based medical education (SBME) is resource and cost intensive, and not offered frequently enough for development of competency and for supporting knowledge retention. Therefore, other methods of training to improve knowledge retention and decision-making are needed. We therefore developed a complementary tool to the physical SBME to improve knowledge retention during neonatal resuscitation in the delivery room. Specifically, we developed a game-based neonatal resuscitation training simulator called RETAIN.

OBJECTIVES
We hypothesized that HCP playing the video game will have an improved mindset and therefore an improved neonatal resuscitation performance.

DESIGN/METHODS
HCPs trained in NRP, including registered nurses, respiratory therapists, neonatal nurse practitioners, neonatal consultants, and neonatal fellows were recruited from the Royal Alexandra Hospital, a tertiary NICU. Each participant was asked to complete a pre-game questionnaire to obtain demographics (e.g. last Neonatal Resuscitation Course (NRP)-course, years of experience) and assess their neonatal resuscitation knowledge by completing a Resuscitation scenario. Afterwards each participant played the RETAIN simulator, which started with a tutorial before the actual three rounds and there was a countdown for each of the rounds to simulate the stress of a real-world scenario. After completion of the game each participant also completed a Post-game questionnaire to assess the player’s mindset (e.g. How much do you agree with the following statements? You can always change how good you are at your job or You can get better at your job with practice) using a Likert scale (1=Strongly Disagree to 5=Strongly agree).

RESULTS
We recruited 50 (45 females, 4 males, and 1 not reported) HCP who were all NRP-trained and had completed a NRP refresher course within the last 24 months. Participants needed a mean (SD) 8.47 (8.66) minutes to complete the game. On average, participants reported high levels of growth mindset (with scores ranging from seven to ten), took their latest NRP course more than eight months prior to the current study, and scored 93% in the game (32 was a perfect score). Interestingly, participants who took the NRP course more recently made more mistakes in the simulation game. There was a significant interaction of Last NRP Course and Growth Mindset in predicting Number of Tries (b =.09, S.E.=.04, beta=.32, t=2.25, p=.03), as well as a main effect for Last NRP Course (b= -.08, S.E.=.04, beta=-.30, t=-2.04, p<.05). Thus, participants who took an NRP course recently (i.e., within eight months), before the current study, completed the game in significantly fewer tries when they endorsed more rather than less of a growth mindset. However, participants who endorsed more of a growth mindset performed similarly on the game regardless of when they took the NRP course.

CONCLUSION
The study examined the relation between HCP task performance and time elapsed since their latest NRP course and found that growth mindset moderates this relation. Specifically, HCP who took the NRP course within the past eight months, those who endorsed a higher growth mindset made fewer mistakes in a simulation game. Some implications include growth mindset interventions and increased opportunities to practice skills in simulation sessions to help HCP achieve better performance after taking a refresher NRP course.