Development and Evaluation of a Rural Longitudinal Neonatal Resuscitation Program Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education)

Abstract

Objective

Neonatal resuscitation is a high-acuity, low-occurrence event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP) guidelines and teamwork.

Study Design

A TS study was conducted monthly in one rural hospital over a 10-month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts, a neonatologist and a simulation educator. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale.

Results

We conducted 10 TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP adherence rate for full code scenarios improved from a baseline of 39 to 95%. Compared with baseline data for efficiency, multiple NRP skills improved (e.g., cardiac lead placement occurred 12× faster, 0:31 seconds vs. 6:21 minutes). Teamwork scores showed improvement in all domains.

Conclusion

Our results demonstrate that a TS program aimed at improving NRP and team performance is possible to implement in a rural setting. Our pilot study showed a trend toward improved NRP adherence, increased skill efficiency, and higher-quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes.

Key Points

• Optimal newborn outcomes depend on skillful implementation of NRP.

• Telesimulation can deliver medical education that circumvents challenges in rural areas.

• A longitudinal NRP TS program is possible to implement in a rural setting.

• A rural NRP telesimulation program may improve interprofessional resuscitation performance.

• A rural NRP telesimulation program may improve interprofessional resuscitation teamwork.

Keywords

simulation - neonatal resuscitation - telesimulation - rural health - interprofessional team training - program development

Authors' Contributions

A.Z. and M.M. conceptualized and designed the study, created data collection tools, conducted the investigation, provided study administration and supervision, drafted the original manuscript, critically reviewed and revised the manuscript. J.H. and M.C. conceptualized the study, conducted the investigation, drafted the original manuscript, critically reviewed, and revised the manuscript. A.Cu and H.S. performed data analysis and visualization of study results and critically reviewed and revised the manuscript. L.M.S. and A.G. provided programmatic and research oversight and drafted, edited, and critically reviewed the manuscript. M.O. conceptualized the study, supported funding acquisition, provided supervision, and critically reviewed and revised the manuscript. A.Cr supported funding acquisition and critically reviewed and revised the manuscript. L.M. conceptualized and designed the study, provided study supervision, drafted the original manuscript, critically reviewed, and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

^* Contributed equally as co-first authors.

Publication History

Received: 28 May 2024

Accepted: 25 September 2024

Accepted Manuscript online:
26 September 2024

Article published online:
22 October 2024

• References

• 1 Tompkins A. American Association of Birth Centers. Maternity care deserts grow across the US as obstetric units shut down. PBS News. Accessed October 11, 2023 at: https://www.pbs.org/newshour/show/maternity-care-deserts-grow-across-the-us-as-obstetric-units-shut-down
• 2 Wood AM, Jones Jr. MD, Wood JH, Pan Z, Parker TA. Neonatal resuscitation skills among pediatricians and family physicians: is residency training preparing for postresidency practice?. J Grad Med Educ 2011; 3 (04) 475-480
• 3 Hunziker S, Johansson AC, Tschan F. et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol 2011; 57 (24) 2381-2388
• 4 Matterson HH, Szyld D, Green BR. et al. Neonatal resuscitation experience curves: simulation based mastery learning booster sessions and skill decay patterns among pediatric residents. J Perinat Med 2018; 46 (08) 934-941
• 5 Patel J, Posencheg M, Ades A. Proficiency and retention of neonatal resuscitation skills by pediatric residents. Pediatrics 2012; 130 (03) 515-521
• 6 McCoy CE, Sayegh J, Alrabah R, Yarris LM. Telesimulation: an innovative tool for health professions education. AEM Educ Train 2017; 1 (02) 132-136
• 7 Hayden EM, Khatri A, Kelly HR, Yager PH, Salazar GM. Mannequin-based telesimulation: increasing access to simulation-based education. Acad Emerg Med 2018; 25 (02) 144-147
• 8 Nelsen BR, Chen YK, Lasic M, Bader AM, Arriaga AF. Advances in anesthesia education: increasing access and collaboration in medical education, from E-learning to telesimulation. Curr Opin Anaesthesiol 2020; 33 (06) 800-807
• 9 Yasser NBM, Tan AJQ, Harder N, Ashokka B, Chua WL, Liaw SY. Telesimulation in healthcare education: a scoping review. Nurse Educ Today 2023; 126: 105805
• 10 Ray JM, Wong AH, Yang TJ. et al. Virtual telesimulation for medical students during the COVID-19 pandemic. Acad Med 2021; 96 (10) 1431-1435
• 11 Manhas DS, Anderson JM. Educational perspectives: telesimulation in neonatal resuscitation. Neoreviews 2014; 15 (12) e514-e517
• 12 van der Heide PA, van Toledo-Eppinga L, van der Heide M, van der Lee JH. Assessment of neonatal resuscitation skills: a reliable and valid scoring system. Resuscitation 2006; 71 (02) 212-221
• 13 Gelbart B, Hiscock R, Barfield C. Assessment of neonatal resuscitation performance using video recording in a perinatal centre. J Paediatr Child Health 2010; 46 (7-8): 378-383
• 14 Fey MK, Roussin CJ, Rudolph JW, Morse KJ, Palaganas JC, Szyld D. Teaching, coaching, or debriefing with good judgment: a roadmap for implementing “with good judgment” across the SimZones. Adv Simul (Lond) 2022; 7 (01) 39
• 15 Arafeh JM, Hansen SS, Nichols A. Debriefing in simulated-based learning: facilitating a reflective discussion. J Perinat Neonatal Nurs 2010; 24 (04) 302-309 , quiz 310–311
• 16 Paige JT, Arora S, Fernandez G, Seymour N. Debriefing 101: training faculty to promote learning in simulation-based training. Am J Surg 2015; 209 (01) 126-131
• 17 Grant VJ, Robinson T, Catena H, Eppich W, Cheng A. Difficult debriefing situations: a toolbox for simulation educators. Med Teach 2018; 40 (07) 703-712
• 18 Rudolph JW, Simon R, Dufresne RL, Raemer DB. There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc 2006; 1 (01) 49-55
• 19 Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc 2016; 11 (03) 209-217
• 20 Textbook of Neonatal Resuscitation. 8 th ed.. American Academy of Pediatrics; 2021
• 21 ImPACTS Collaborative. https://www.impactscollaborative.com/resources-for-hubs-nicu
• 22 Malec JF, Torsher LC, Dunn WF. et al. The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills. Simul Healthc 2007; 2 (01) 4-10
• 23 Gardner AK, Kosemund M, Martinez J. Examining the feasibility and predictive validity of the SAGAT tool to assess situation awareness among medical trainees. Simul Healthc 2017; 12 (01) 17-21
• 24 Ballangrud R, Persenius M, Hedelin B, Hall-Lord ML. Exploring intensive care nurses' team performance in a simulation-based emergency situation, - expert raters' assessments versus self-assessments: an explorative study. BMC Nurs 2014; 13 (01) 47
• 25 Curry L, Gass D. Effects of training in cardiopulmonary resuscitation on competence and patient outcome. CMAJ 1987; 137 (06) 491-496
• 26 Langdorf MI, Strom SL, Yang L. et al. High-fidelity simulation enhances ACLS training. Teach Learn Med 2014; 26 (03) 266-273
• 27 Toft LEB, Bottinor W, Cobourn A. et al. A simulation-enhanced, spaced learning, interprofessional “code blue” curriculum improves ACLS algorithm adherence and trainee resuscitation skill confidence. J Interprof Care 2023; 37 (04) 623-628
• 28 Au K, Lam D, Garg N. et al. Improving skills retention after advanced structured resuscitation training: a systematic review of randomized controlled trials. Resuscitation 2019; 138: 284-296
• 29 Dempsey E, Pammi M, Ryan AC, Barrington KJ. Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants. Cochrane Database Syst Rev 2015; 2015 (09) CD009106
• 30 Duran R, Aladağ N, Vatansever U, Küçükuğurluoğlu Y, Süt N, Acunaş B. Proficiency and knowledge gained and retained by pediatric residents after neonatal resuscitation course. Pediatr Int 2008; 50 (05) 644-647
• 31 Haynes J, Rettedal S, Perlman J, Ersdal H. A randomised controlled study of low-dose high-frequency in-situ simulation training to improve newborn resuscitation. Children (Basel) 2021; 8 (12) 1115
• 32 Huynh T, Mamidi R, Lapcharoensap W. Impact of repeat simulated neonatal resuscitation training on neonatal resuscitation program algorithm adherence in a community hospital. Pediatrics 2020; 146 (146) 338-339
• 33 Barbato AL, Wetzel EA, Li W, Bo N, Mayer L, Byrne BJ. Simulation education for preterm infant delivery room management at community hospitals. Pediatrics 2020; 146 (06) e20193688
• 34 Kaye W, Mancini ME, Rallis SF. et al. Can better basic and advanced cardiac life support improve outcome from cardiac arrest?. Crit Care Med 1985; 13 (11) 916-920
• 35 Skidmore MB, Urquhart H. Retention of skills in neonatal resuscitation. Paediatr Child Health 2001; 6 (01) 31-35
• 36 Krafft PM. A simple computational theory of general collective intelligence. Top Cogn Sci 2019; 11 (02) 374-392
• 37 Radcliffe K, Lyson HC, Barr-Walker J, Sarkar U. Collective intelligence in medical decision-making: a systematic scoping review. BMC Med Inform Decis Mak 2019; 19 (01) 158
• 38 Wolf M, Krause J, Carney PA, Bogart A, Kurvers RH. Collective intelligence meets medical decision-making: the collective outperforms the best radiologist. PLoS One 2015; 10 (08) e0134269
• 39 Keilman A, Reid J, Thomas A. et al. Enhancing paediatric resuscitation team performance: targeted simulation-based team leader training. BMJ Simul Technol Enhanc Learn 2020; 7 (01) 44-46
• 40 Ediger K, Rashid M, Law BHY. What is teamwork? A mixed methods study on the perception of teamwork in a specialized neonatal resuscitation team. Front Pediatr 2022; 10: 845671
• 41 Mileder LP, Bereiter M, Wegscheider T. Telesimulation as a modality for neonatal resuscitation training. Med Educ Online 2021; 26 (01) 1892017