274 - Randomized Trial of Educational Strategies to Improve the Quality of Positive Pressure Ventilation Provided by Pediatric Residents During Neonatal Resuscitation

Poster Number: 274
Publication Number: 274.331

Catherine Chang, Weill Cornell Medicine, New York, NY, United States; Jeffrey Perlman, Weill Cornell Medicine, New York City, NY, United States; Bridget Grogan, Weill Cornell Medicine, rockaway park, NY, United States; Anjile An, Weill Cornell Medicine, New York, NY, United States; Erika Abramson, Weill Cornell Medicine, New York, NY, United States

Background: Rapid cycle, deliberate practice (RCDP) is a training method involving repetitive simulation practice interjected by frequent, succinct feedback from faculty. It that has been shown to improve performance of resuscitation skills and may be superior to traditional, facilitated debriefing methods in groups of learners. However, its effects on individual performance are undocumented.

Objective: Determine whether RCDP, compared with traditional debriefing, results in greater improvement in quality of positive pressure ventilation (PPV) provided by pediatric residents immediately after individual training, and on short term follow-up. We hypothesized that RCDP will result in greater improvement in quality of PPV at both time points.

Design/Methods: This was a prospective, randomized, simulation-based study. Residents were block randomized to receive traditional, facilitated debriefing or RCDP during individual training sessions with a Neonatal Resuscitation Program (NRP) instructor (See Fig 1). A prototype NeoNatalie Live manikin (Laerdal Global Health) was utilized to measure bag mask ventilation pressure and rate, and record participant performance. PPV performance at baseline, post-teaching and on short-term follow up were compared between the two groups for % of initial ventilations delivered within goal pressure range (20-30 cmH2O), PPV initiation within the 1st minute of life and PPV at goal rate (40-60/minute). Fisher’s Exact test, Wilcoxon rank-sum test, Wilcoxon signed rank test, and McNemar’s test were used to assess differences between groups.

Results: We enrolled 57 participants (21 PGY3s, 15 PGY2s, 21 PGY1s) with Sim 1, 2 and 3 data. 72% were female. 46 participants had additional short term follow-up data (Sim4). There were no significant differences between improvements seen between traditional debriefing and RCDP groups related to the quality metrics of PPV evaluated. All participants demonstrated a significant increase in % of initial ventilations delivered within goal pressure, from 25% (pre-teaching) to 55% (post-teaching), (p < 0.0001). Following training, more residents initiated PPV within the first minute (p=0.006). There was no significant loss of skills on short term follow up [see Table 1].Conclusion(s): Pediatric residents improved their quality of PPV delivered (related to pressure and time of initiation of PPV) regardless of training method. This improvement is retained in short term follow-up. The lack of expected difference between RCDP and traditional, facilitated debriefing may have been related to the intensive, individualized nature of the training sessions for both groups.
Figure 1. Study Design
Table 1. PPV performance by educational method and overall (all participants, regardless of educational method)