52 Simulation-based Team-Leadership training for Neonatal Resuscitation: Is learning by Observation as effective as learning by Participation?

Abstract

Completion of NRP courses and NICU rotations during residency program does not usually prepare pediatric residents to ‘lead’ neonatal resuscitation teams adequately. Simulation can be used as an adjunct tool to consolidate teamwork skills, and develop leadership potential. In reality many learners end up observing rather than participating in simulation due to logistics and time constraints. Purpose: To evaluate if being an observer versus participating in a simulation training session influenced performance in neonatal resuscitations. Primary Objective: We compared the relative effectiveness in learning of non-technical skills by Observation vs. Participation in simulation-based training in neonatal resuscitation. Secondary Objective: (i) Compare the changes in stress measures between participants and observers (ii) assess if participating in simulation increases stress levels among learners and check if stress during simulation associated with enhanced learning. True experiment design (Pre-test, Post-test 2-intervention group) was used. Senior pediatric trainees from the paediatrics and neonatal programmes were invited to participate. Confederates were used as nurse and respiratory therapist. Scenarios were standardized and conducted in high-fidelity simulation center. All trainees took part in pre-test; each led resuscitation on a simulated NRP scenario, followed by Didactic teaching incorporating principles in teamwork and leadership. Participant group performed 3 simulated resuscitations, while Observer group observed via closed-circuit television. Both groups were video-debriefed together using standardized Pearls methodology. Retention tests were performed 6–8 weeks later. Both pre-and retention-tests were video-taped for later review by 2 independent evaluators using pre-validated assessment tools. Stress Indicators: Salivary cortisol levels (objective stress indicator) were collected from all trainees at specific time points. Trainees self reported their perceived levels of anxiety/stress (subjective stress indicator) answering questionnaire. 22 pediatric trainees were randomized into participant group (n=11) and observer group (n=11). There were no differences in clinical experience between these groups, baseline stress levels, or time since their last NRP course. Both groups improved their NRP performance and experienced stress during the simulation. Simulated neonatal resuscitation training was associated with improved skills in learners regardless of whether they participated or observed.