603 - Simulation-based neonatal resuscitation training for pediatric residents at St. Christopher's hospital for children

Poster Number: 603
Publication Number: 603.118

Swosti Joshi, St. Christopher's Hospital for Children, Phialdelphia, PA, United States; Sonal Goenka, St. Christopher's Hospital for Children, Philadelphia, PA, United States

Background: The Neonatal Resuscitation Program (NRP) provides the skills needed to resuscitate neonates during birth. Pediatric residents are expected to learn about the NRP algorithm and basic skills. Change of duty hours rules in residency has decreased residents' opportunities to practice the basic resuscitation skills in the delivery room (DR). In our institution, a tertiary neonatal intensive care unit (NICU), the closure of the DR unit in 2019 further significantly impacted their opportunities to learn DR resuscitation skills. As an alternative, simulation-based training was initiated to fill the educational gap.

Objective: We hypothesize that simulation-based training will improve pediatric residents' confidence, knowledge, and skills needed for the successful resuscitation of neonates.

Design/Methods: A monthly high-fidelity simulation of NRP based scenarios was conducted from 10/2019-10/2020. During their NICU rotation, residents participated in a standard 60-minute (min) simulation with a 15-min scenario and 30-min debriefing. They filled out a pre-and post-questionnaire with a Likert-type scale about perceived comfort in assisting neonatal resuscitation, knowledge of NRP, and simulation satisfaction survey.

From 11/2020-11/2021, the stimulation frequency increased to twice a NICU block. The traditional 60 min simulation structure was modified to a 10-min scenario, 20-min debriefing, and 20-min skill station. Data was collected and analyzed.

Results: In the first session, 29 pre-post surveys were collected. Regarding subjective data, there was a significant improvement in the resident's comfort level in knowledge of NRP, performing initial steps of resuscitation, and bag and mask ventilation. Although it was not statically significant, there was a trend towards increased comfort in attending deliveries. There was a significant improvement in knowledge about the initial steps of resuscitation and a trend towards improvement in all other knowledge-based questions (Table 1).

In the second session, 87 pre-post surveys were collected. There was a significant improvement in all subjective and knowledge-based variables (p < 0.001). Regarding simulation satisfaction surveys, the resident felt scenarios depicted real-life experience and that the simulation and debriefing sessions were educational (Table 2).Conclusion(s): This study showed that for pediatric residents who have decreased real-life opportunities to practice resuscitation skills in the DR, frequent and structured NRP based high fidelity simulation with the addition of a skills station significantly improved subjective confidence and knowledge.
Table 1. Variables related to comfort and knowledge about neonatal resuscitationPPV: positive pressure ventilation ; SD: standard deviation ; NRP: Neonatal resuscitation program ; MRSOPA: acronym for ventilation corrective steps:M (mask adjustment), R (reposition airway), S (suction mouth and nose), O (open mouth), P (pressure increase), A (alternate airway)
Table 2 Simulation satisfaction survey