Resuscitation of the Newborn: Simulating for Confidence

Abstract

IntroductionNon-pediatric trainees working in pediatrics in the UK are expected to attend newborn deliveries and provide initial newborn life support if needed. In Swindon, new junior doctors receive a 90-minute teaching session at the start of their pediatrics rotation, but the content has not previously been standardized, and it may be several weeks before a doctor attends a newborn delivery. Thus, the confidence and competence in newborn resuscitation of doctors attending deliveries can vastly vary.MethodsA standardized teaching package was developed as part of the pediatrics induction program. This includes an interactive lecture on the physiology of the newborn, skills stations, and mini-simulations to consolidate skills. This is accompanied by a program of regular neonatal mini-simulations as part of the departmental morning teaching program. These sessions allow junior doctors to practice their skills in a safe, simulated environment and reinforce the newborn life support pathway.ResultsQualitative and quantitative feedback was sought following delivery of the induction training session. Junior doctors were asked to rate their confidence before and after the induction session using Likert scales from 1 (least confident) to 5 (most confident). Median confidence in attending term deliveries increased from 2 (range 1 - 4) to 4 (2 - 5), P=0.008. There was evidence that confidence was maintained at one month following induction.ConclusionsA simulation program has been successful at improving confidence among junior doctors in attending newborn deliveries. This has the potential to improve patient care and trainees’ experiences of their pediatrics placement.

Implementation Lessons from a Multifaceted National Newborn Program in Solomon Islands: A Mixed-Methods Study

“…Few studies have documented the qualitative experience of resuscitation for healthcare workers in low-and middle-income countries. [44][45][46][47] Whereas many studies and guidelines outline the equipment, algorithms, and approach, the challenging nature of a resuscitation event, and its subsequent weighing on the mind of the healthcare worker, is not well described. Support in dealing with stressful experiences is an important component of a well-performing and motivated workforce.…”

Relationship between psychological characteristics, personality traits, and training on performance in a neonatal resuscitation scenario: A machine learning based analysis

“…Findings from previous studies mostly focused on the link between self-confidence (one's general perceptions of the self in given domains of functioning) and performance in a simulated resuscitation scenario (6,(36)(37)(38), as well as the improvement of self-efficacy (person's judgements of his or her capabilities to organize and execute courses of actions) with training (39)(40)(41). In our study, we focused on internality vs. externality control belief (FKK), thought understanding how people takes responsibility of own action may play a major role in such a scenario.…”

“…Furthermore, environmental factors such as setting, surroundings (1,2), and medical equipment (3) also have a significant impact on providers' performance during emergencies and thus, the patients' outcome. However, mastering emergency situations may not only be linked to the above-mentioned factors, but may also depend on other factors such as group dynamics (e.g., teamwork, leadership, team hierarchy) (4), and personal mental state (e.g., fatigue, stress) (5,6). It is therefore reasonable that performers' personality traits and anxiety also can affect performance during emergencies situations.…”

“…It is therefore reasonable that performers' personality traits and anxiety also can affect performance during emergencies situations. In this study, we examined the impact of personality traits, anxiety, and training on the performance in a demanding medical care training scenario for critically ill newborns in the delivery room (6). We chose this scenario as there is evidence that health care professionals estimate emergencies as being even more challenging when children are involved (7).…”

“…We chose this scenario as there is evidence that health care professionals estimate emergencies as being even more challenging when children are involved (7). Extensive resuscitation after birth is a rare event with fewer than 0.3% of all deliveries (6,8,9), and therefore the Newborn Life Support (NLS) algorithm needs to be trained in simulation settings on a regular basis. It has been shown that trainees' stress levels are increased in a simulated resuscitation setting as they are in real settings (10), and that high stress in healthcare providers worsens cognitive processes (e.g., attention, working memory, decision making) and consequently lead to poor patient outcomes (11).…”