A Medical Simulation‐based Educational Intervention for Emergency Medicine Residents in Neonatal Resuscitation

Abstract

Objectives: The objective was to determine if a medical simulation-based neonatal resuscitation educational intervention is a more effective teaching method than the current emergency medicine (EM) curriculum at one 4-year EM residency program.Methods: A prospective, randomized study of second-, third-, and fourth-year EM residents was performed. Of 36 potential subjects, 27 residents were enrolled. Each resident was assessed at baseline and after the intervention using 1) a questionnaire to evaluate confidence in leading adult, pediatric, and neonatal resuscitation and prior neonatal resuscitation experience and 2) a neonatal resuscitation simulation scenario in which each participant was the code leader to evaluate knowledge and skills. Assessments were digitally recorded and reviewed independently by two Neonatal Resuscitation Program (NRP) instructors using a validated neonatal resuscitation scoring tool. Controls (15 participants) received the current EM curriculum. The intervention group (12 participants) experienced an educational session, which incorporated didactics, skills station, and medical simulation about neonatal resuscitation. Outcomes measured included changes in overall neonatal resuscitation score, number of critical actions, time to initial steps of neonatal resuscitation, and changes in confidence level leading neonatal resuscitation.Results: Baseline neonatal resuscitation scores were similar for the control and intervention groups. At the final assessment, the intervention group's neonatal resuscitation score improved (p = 0.016) and the control group's score did not. The intervention group performed 2.31 more critical actions overall and the time to achieve warming (p = 0.0002), drying (p < 0.0001), tactile stimulation (p = 0.002), and placing a hat on the patient (p <0.0001) were also improved compared to controls. At the baseline assessment, 80% of the control group and 75% of the intervention group reported being ''not at all confident'' in leading neonatal resuscitation. At the final assessment, the proportion of residents who were ''not at all confident'' leading neonatal resuscitation decreased to 35% in the intervention group compared to 67% of the control group. The majority of the intervention group (65%) reported an increased level of confidence in leading neonatal resuscitation.Conclusions: Medical simulation can be an effective tool to assess the knowledge and skills of EM residents in neonatal resuscitation. Our simulation-based educational intervention significantly improved EM residents' knowledge and performance of the critical initial steps in neonatal resuscitation. A medical simulation-based educational intervention may be used to improve EM residents' knowledge and performance with neonatal resuscitation.

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2012

“…Research methodology included 17 surveys (36%), 17,19,21,25,30,31,33,37,40,42,46,[50][51][52]54,60,61 15 (31%) observational analyses, [14][15][16]22,23,27,32,33,38,44,47,49,56,57,59 and three (6%) qualitative methodology studies. 19,28,45 There were only 12 (25%) with an experimental or quasi-experimental study design, 20,24,26,35,36,39,41,43,48,53,55,57 with five of the highlighted articles using this rigorous design. 35,36,41,…”

“…19,28,45 There were only 12 (25%) with an experimental or quasi-experimental study design, 20,24,26,35,36,39,41,43,48,53,55,57 with five of the highlighted articles using this rigorous design. 35,36,41,43,55 These trends are summarized in Table 3.…”

“…33,41,43 Seven of these focused on learner satisfaction or self-assessment regarding the simulation experience, while nine were outcomes based. 22,32,33,38,39,41,43,56,57 Five articles studied ultrasound in EM, 21,47,49,59,61 and two employed visual technology. 55,58 A positive trend this year was the emergence of more competency-based studies, which reflect a higher order of research outcomes in medical education, based on the Kirkpatrick model.…”

“…Seven quantitative studies met a priori criteria as methodologically superior publications in education research. 33,35,36,41,43,46,55 …”

Preparedness of urban, general emergency department staff for neonatal resuscitation in a Canadian setting

“…17,18 Lee and colleagues evaluated the change in score achieved on a validated neonatal resuscitation scoring tool among emergency medicine residents who undertook neonatal resuscitation simulation training compared to residents exposed to a traditional curriculum. 19 They concluded that simulation-based educational interventions may be used to improve emergency medicine residents' knowledge of and performance with neonatal resuscitation. Allan and colleagues described and evaluated an interprofessional simulation-based educational program within a busy 24-bed pediatric cardiac intensive care unit.…”