The Role of Simulation in Health Education Globally: A Review of the Neonatal Resuscitation Program and Helping Babies Breathe

Abstract

In 2010, the Neonatal Resuscitation Program became the first life support resuscitation program to formally incorporate simulation- based training with debriefing as an educational methodology. Concurrently, a simplified simulation-based neonatal resuscitation program called Helping Babies Breathe (HBB) was created, with the goal of providing low-cost, portable programming to teach basic neonatal resuscitation to birth attendants in low- and middle-income countries. Early studies evaluating the efficacy of HBB demonstrated that facility- based implementation has the potential to reduce rates of early (<24 hour) neonatal mortality and stillbirth. Subsequent investigations that have coupled HBB training with quality improvement efforts, ongoing practice, and refresher training have shown even greater effect on neonatal mortality and stillbirth rates. However, the ideal frequency of skills practice and refresher training required to retain resuscitation skills remains poorly defined. Challenges exist in defining optimal practices, as recommendations may vary by the cadre of health care professional, education level, and access to ongoing delivery room experience. While simulation-based strategies have been shown to be effective at improving educational and clinical outcomes, the use of simulation in global health settings is challenged by hurdles such as resource limitations (complex equipment, supply chain, and expense), time intensity, dependence on skilled educators, and acceptance of simulation as a teaching strategy.