Acquisition of Behavioral Skills after Manikin-Based Simulation of Neonatal Resuscitation by Fellows in Neonatology

Abstract

Objective Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation.

Study Design From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation.

Results Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance.

Conclusion An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training.

Key Points

• Simulation training should improve technical and behavioral skills of providers

• Behavioral skills improve after a first cycle of training, but not after a repeat cycle

• Anxiety modulates trainees' behavioral performance

Keywords

cardiopulmonary resuscitation - newborn - simulation training - behavioral rating scale - anxiety - internship and residency - behavior

Note

This manuscript is being submitted only to BMC Medical Education, and it will not be submitted elsewhere while under consideration. All authors read, reviewed, and approved the final version of the manuscript.

Ethical Approval

The research protocol was approved by the Ethics Committee of Federal University of São Paulo (Unifesp—Escola Paulista de Medicina), approval number: 3.128.093. All methods were performed in accordance with the precepts of the Declaration of Helsinki and the Nuremberg Code, respecting the Standards for Research involving human beings of the National Health Council. An informed written consent was obtained from all participants of the study.

Data Availability Statement

The complete database is available on request with the corresponding author.

Authors' Contributions

M.D.M.G., R.G., and J.F.M.O. have participated in the concept and design, analysis and interpretation of data, and drafting and revising the manuscript. A.S. has participated in design, statistical analysis and interpretation of data, and drafting and revising the manuscript. A.C.Y.P., M.F.C., M.D.K., M.H.M., and M.F.B.A. have participated in the design of the study, interpretation of data, and revising the manuscript. All authors listed on the manuscript approved the submission of this version of the manuscript and take full responsibility for the manuscript. The authors declare that they do not have any conflict of interest. None of authors received any form of payment to produce the manuscript.

Publication History

Received: 25 November 2021

Accepted: 08 March 2022

Accepted Manuscript online:
10 March 2022

Article published online:
12 May 2022

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