22 Neonatal regional outreach education in Quebec – a formal needs assessment

Abstract

Abstract Background In Montreal (Quebec, Canada), newborn care is provided in either highly specialized hospitals for complex/critically ill patients or community hospitals for healthier patients. Community health care practitioners (CHP) have varying levels of comfort and competency in newborn care. Also, because of the unpredictable nature of obstetrics, CHP will need to manage critically ill newborns throughout their careers. Such high acuity, low frequency events can be difficult to manage even in experienced hands. Therefore, there is an imperative to develop a neonatal training curriculum for CHP, with an emphasis on critical newborns. Objectives As a first step, the objective of this study was to perform a comprehensive needs assessment of neonatal outreach education for CHP working in the Greater Montreal Area (Quebec, Canada). Design/Methods Using a mixed methods design (figure), the needs assessment was divided in 3 sections. First, the felt educational needs of the target population (CHP) using an online questionnaire. Second, through focus group discussion, the normative needs of the medical personnel who transport critical newborns. Third, the expressed educational needs of CHP through analysis of neonatal transport data between 2017-2020. Quantitative data was analyzed using descriptive statistics, including means and medians. Qualitative data was coded using conventional content analysis, with the primary technique being descriptive and pattern coding. Results The questionnaire reached 158 participants across 13 community hospitals. CHP are seeking training with procedures, critical situations, and resuscitation. Also, resource sharing, more field expertise, and additional resources for training (time, credits) were identified. Three focus groups (15 participants) also revealed that procedural training, critical newborn management and ventilation were important, as well as Crisis Resource Management (CRM) training. Both the questionnaire and focus groups identified specific medical conditions of interest. The expressed needs (transport data, 947 transports) helped reinforce felt and normative needs. Simulation was identified as a key educational technique. Conclusion A neonatal educational outreach curriculum will need to include procedural training, CRM teaching and certain specific medical conditions including extreme prematurity, hypoxic-ischemic encephalopathy (HIE) and pneumothorax. Procedural training and the principles of ventilation are also critically important. Simulation should be integral, in situ and with varied content. The fear of being judged is omnipresent and should be recognized during outreach education. Educational resources should be shared on an easily accessible, central website.