Time for a New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment

Halamek, Louis P.; Kaegi, David; Gaba, David M.; Sowb, Yasser A.; Smith, Baird M.; Smith, Brian E.; Howard, Steven K.

doi:10.1542/peds.106.4.e45

Cited by 264 publications

(125 citation statements)

References 6 publications

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“…This is due in part to expert groups such as the Institute of Medicine and regulators like the Joint Commission for Accreditation of Health-care Organizations who advocate some type of team training. In addition, research suggests the need for improved teamwork and communication in neonatal intensive care, 2,3,16 emergency departments, 10 the operating room, 17,18 trauma resuscitation [19][20][21] and among residents of all disciplines. 22 Despite this interest and research, two recent reviews concluded that no studies have shown that team training can improve teamwork and the quality of care, 11,12 and a cluster randomized trial of team training for labor and delivery teams did not find significant changes in the process of care or outcome measures.…”

Section: Discussionmentioning

confidence: 99%

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

et al. 2007

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Objective: To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course.Study design: Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance. IntroductionThe Neonatal Resuscitation Program (NRP) is the standard curriculum used to teach caregivers how to treat newborns in the delivery room. Worldwide, the NRP could improve outcomes of thousands of newborns per year. 1 However, approximately 30% of NRP steps are not performed or performed incorrectly, 2,3 and pediatric residents often fail to intubate infants correctly. 4 Neonatal resuscitation should be a team activity that involves at least two people who work together to achieve a shared goal. 5 Breakdowns in teamwork may contribute to the quality problems noted above. For example, team behaviors are correlated with the quality of neonatal resuscitation, 3 communication breakdowns are root cause of 72% of perinatal deaths and injuries, 6 perceptions of effective teamwork are correlated with less burnout and fewer delays in labor and delivery, 7 and there is broad consensus from expert groups and researchers that measuring and improving teamwork will help improve the quality of health care. [8][9][10] However, none of the nine lessons in the NRP textbook 1 includes instruction about teamwork, in part because no studies have shown that team training can improve either teamwork or the quality of health care. 11,12 Therefore, we conducted a study with two specific aims: (1) to incorporate teamwork skills and information about human error into the 1-day NRP training program for interns and (2) to randomize interns to this new version of NRP or the standard NRP and measure the effects on teamwork during the simulated resuscitations at the end of the day. We hypothesized that it would be feasible to add the teamwork training to the 1-day NRP course, and that interns who were randomized to the NRP course with team training would exhibit more teamwork behaviors during the simulated resuscitation than would the interns in the standard NRP course.

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Section: Discussionmentioning

confidence: 99%

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

et al. 2007

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“…In accordance with international programs, nurses can and should be trained for delivery-room care of the newborn, so that they can help the pediatrician or, in their absence, perform the initial procedures of neonatal resuscitation. 26,27 In Brazil, nurses can perform the initial steps of resuscitation and ventilation with bag and mask, in addition to helping pediatricians with chest compressions, intubation and drug administration. 28 Training of nursing students in the basic procedures of resuscitation, as recommended by the Brazilian Society of Pediatrics, 28 could contribute to reduce morbidity and mortality due to perinatal asphyxia in our country.…”

Section: Discussionmentioning

confidence: 99%

Ensino da reanimação neonatal em maternidades públicas das capitais brasileiras

Almeida¹,

Guinsburg²,

Costa³

et al. 2005

J. Pediatr. (Rio J.)

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“…31,32 In neonatology, simulations are used as training tools to improve team performance in neonatal resuscitation. 33,34 Louis Halamek was contacted by a member of Wee Deliver and after interview and discussion graciously agreed to be an expert resource and advisor for the group. The group's aim was improved team performance during high-risk delivery and newborn resuscitation.…”

Section: Methodsmentioning

confidence: 99%

Evaluation and Development of Potentially Better Practices for Perinatal and Neonatal Communication and Collaboration

Ohlinger

Kantak²,

Lavin

et al. 2006

Pediatrics

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OBJECTIVE. The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration.METHODS. Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes.RESULTS. As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal-perinatal team communication.CONCLUSIONS. Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.www.pediatrics.org/cgi

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Time for a New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment

Abstract: Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.

Cited by 264 publications

References 6 publications

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

Ensino da reanimação neonatal em maternidades públicas das capitais brasileiras

Evaluation and Development of Potentially Better Practices for Perinatal and Neonatal Communication and Collaboration

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