Klin Padiatr 2014; 226(05): 259-267
DOI: 10.1055/s-0034-1372621
Review
© Georg Thieme Verlag KG Stuttgart · New York

Simulation-Based Neonatal and Infant Resuscitation Teaching: A Systematic Review of Randomized Controlled Trials

Simulationsbasierte Ausbildung in der Reanimation von Neugeborenen und Kindern: Ein systematischer Review randomisierter kontrollierter Studien
L. P. Mileder
1   Clinical Skills Center, Medical University of Graz, Graz, Austria
2   Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
,
B. Urlesberger
2   Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
,
E. G. Szyld
3   Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States of America
,
C. C. Roehr
4   Department of Neonatology, Charité, Universitätsmedizin Berlin, Berlin, Germany
5   Neonatal Research Unit, The Royal Women’s Hospital, Melbourne, Australia
6   The Ritchie Centre, Monash University, Melbourne, Australia
7   Dieter Scheffner Fachzentrum für medizinische Hochschullehre und ­evidenzbasierte Ausbildungsforschung, Charité, Universitätsmedizin Berlin, Berlin, Germany
,
G. M. Schmölzer
2   Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
8   Department of Pediatrics, University of Alberta, Edmonton, Canada
9   Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
25 August 2014 (online)

Abstract

Background: Current resuscitation guidelines recommend the use of simulation-based medical education (SBME) as an instructional methodology to improve patient safety and health. We sought to investigate the evidence-base for the effectiveness of SBME for neonatal and pediatric resuscitation training.

Method: Therefore, we conducted a systematic literature research of electronic databases (PubMed, EMBASE, Clinical Trials).

Results: 13 randomized controlled trials with a total of 832 participants were identified. However, due to distinct differences in research objectives and varying outcome assessment a meta-analysis of studies could not be conducted. Eligible trials showed that SBME can enhance trainees’ cognitive, technical, and behavioral skills as well as self-confidence.

Discussion/Conclusion:Skills acquired in the simulated environment can be integrated in clinical practice, and SBME might also lead to improved patient safety and health. Further research on SBME – especially investigating patient outcomes – is urgently required in order to strengthen these results and to establish a sound evidence-base for the effectiveness of SMBE for neonatal and infant resuscitation training.

Zusammenfassung

Hintergrund: Aktuelle Reanimationsrichtlinien empfehlen die Nutzung von simulationsbasierter Ausbildung zur Verbesserung von Patientensicherheit und -gesundheit. Wir untersuchten die Evidenz für die Effektivität simulationsbasierter Ausbildung in der Neugeborenen- und Kinderreanimation.

Methode: Wir führten eine systematische Literaturanalyse in elektronischen Datenbanken (PubMed, EMBASE, Clinical Trials) durch.

Ergebnisse: 13 randomisierte kontrollierte Studien mit einer Gesamtteilnehmerzahl von 832 wurden gefunden. Aufgrund ausgeprägter Unterschiede bei Fragestellungen und Auswertemodalitäten konnte keine Meta-Analyse der Studien durchgeführt werden. Die Studien zeigten, dass simulationsbasierte Ausbildung kognitive, technische und verhaltensbezogene Fertigkeiten ebenso wie Selbstbewusstsein der Trainingsteilnehmer positiv beeinflussen kann.

Diskussion/Schlussfolgerung: In einem simulierten Umfeld erworbene Fertigkeiten können in die klinische Tätigkeit umgesetzt werden, und simulationsbasierte Ausbildung kann darüber hinaus zu verbesserter Patientensicherheit und -gesundheit führen. Weitere Untersuchungen zu simulationsbasierter Ausbildung – insbesondere in Bezug auf das Patienten-Outcome – sind dringend erforderlich, um diese Ergebnisse zu untermauern und eine solide Evidenz für die Effektivität in Zusammenhang mit Neugeborenen- und Kinderreanimation zu etablieren.

 
  • References

  • 1 Abrahamson S, Denson JS, Wolf RM. Effectiveness of a simulator in training anesthesiology residents. J. Med Educ 1969; 44: 515-519
  • 2 Andreatta P, Saxton E, Thompson M et al. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med 2011; 12: 33-38
  • 3 Barsuk JH, McGaghie WC, Cohen ER et al. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med 2009; 37: 2697-2701
  • 4 Bould MD, Hayter MA, Campbell DM et al. Cognitive aid for neonatal resuscitation: a prospective single-blinded randomized controlled trial. Br J Anaesth 2009; 103: 570-575
  • 5 Campbell DM, Barozzino T, Farrugia M et al. High-fidelity simulation in neonatal resuscitation. Paediatr Child Health 2009; 14: 19-23
  • 6 Cavaleiro AP, Guimarães H, Calheiros FL. Training neonatal skills with simulators?. Acta Paediatr 2009; 98: 636-639
  • 7 Cheng A, Hunt EA, Donoghue A et al. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr 2013; 167: 528-536
  • 8 Cook DA, Hatala R, Brydges R et al. Technology-enhanced simulation for health professions education – a systematic review and meta-analysis. JAMA 2011; 306: 978-988
  • 9 Curran VR, Aziz K, O’Young S et al. Evaluation of the effect of a computerized training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn Med 2004; 16: 157-164
  • 10 Donoghue AJ, Durbin DR, Nadel FM et al. Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial. Pediatr Emerg Care 2009; 25: 139-144
  • 11 Donoghue AJ, Durbin DR, Nadel FM et al. Perception of realism during mock resuscitations by pediatric housestaff: the impact of simulated physical features. Simul Healthc 2010; 5: 16-20
  • 12 Draycott TJ, Crofts JF, Ash JP et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol 2008; 112: 14-20
  • 13 Draycott T, Sibanda T, Owen L et al. Does training in obstetric emergencies improve neonatal outcome?. BJOG 2006; 113: 177-182
  • 14 Fritz PZ, Gray T, Flanagan B. Review of mannequin-based high-fidelity simulation in emergency medicine. Emerg Med Australas 2008; 20: 1-9
  • 15 Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004; 13: i2-i10
  • 16 Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 1988; 69: 387-394
  • 17 Grant EC, Marczinski CA, Menon K. Using pediatric advanced life support in pediatric residency training: does the curriculum need resuscitation?. Pediatr Crit Care Med 2007; 8: 433-439
  • 18 Griswold S, Ponnuru S, Nishisaki A et al. The emerging role of simulation education to achieve patient safety: translating deliberate practice and debriefing to save lives. Pediatr Clin North Am 2012; 59: 1329-1340
  • 19 Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med 2008; 13: 448-453
  • 20 Halamek LP, Kaegi DM, Gaba DM et al. Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment. Pediatrics 2000; 106: e45
  • 21 Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies, Cochrane handbook for systematic reviews of interventions, Version 5.1.0. Edited by. Higgins JPT, Green S. The Cochrane Collaboration. 2011. Available at: http://www.cochrane-handbook.org [Accessed November 14, 2012]
  • 22 Hunt EA, Shilkofski NA, Stavroudis TA et al. Simulation: translation to improved team performance. Anesthesiol Clin 2007; 25: 301-319
  • 23 Issenberg SB, McGaghie WC, Hart IR et al. Simulation technology for health care professional skills training and assessment. JAMA 1999; 282: 861-866
  • 24 Issenberg SB, McGaghie WC, Petrusa ER et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28
  • 25 Joint Commission on Accreditation of Healthcare Organizations Sentinel Event Alert – Issue 30: Preventing infant death and injury during delivery. 2004 Available at: http://www.jointcommission.org/assets/1/18/SEA_30.PDF [Accessed November 30, 2013]
  • 26 Kaczorowski J, Levitt C, Hammond M et al. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Fam Med 1998; 30: 705-711
  • 27 Kory PD, Eisen LA, Adachi M et al. Initial airway management skills of senior residents: simulation training compared with traditional training. Chest 2007; 132: 1927-1931
  • 28 Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team . 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365: 891-900
  • 29 Lee MO, Brown LL, Bender J et al. A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation. Acad Emerg Med 2012; 19: 577-585
  • 30 Lynagh M, Burton R, Sanson-Fisher R. A systematic review of medical skills laboratory training: where to from here?. Med Educ 2007; 41: 879-887
  • 31 Maran NJ, Glavin RJ. Low- to high-fidelity simulation – a continuum of medical education?. Med Educ 2003; 37: 22-28
  • 32 Mayo PH, Hackney JE, Mueck JT et al. Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator. Crit Care Med 2004; 32: 2422-2427
  • 33 McGaghie WC, Draycott TJ, Dunn WF et al. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc 2011; 6: S42-S47
  • 34 McGaghie WC, Issenberg SB, Cohen ER et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011; 86: 706-711
  • 35 McGaghie WC, Issenberg SB, Petrusa ER et al. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 2006; 40: 792-797
  • 36 McGaghie WC, Siddall VJ, Mazmanian PE et al. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 2009; 135: 62 S-68 S
  • 37 Mileder LP, Urlesberger B, Schwindt J et al. Compliance with guidelines recommending the use of simulation for neonatal and infant resuscitation training in Austria. Klin Padiatr 2014; 226: 24-28
  • 38 Morey JC, Simon R, Jay GD et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002; 37: 1553-1581
  • 39 Nadel FM, Lavelle JM, Fein JA et al. Teaching resuscitation to pediatric residents: the effects of an intervention. Arch Pediatr Adolesc Med 2000; 154: 1049-1054
  • 40 O’Donnell CP, Kamlin CO, Davis PG et al. Interobserver variability of the 5-minute Apgar score. J Pediatr 2006; 149: 486-489
  • 41 Patel D, Piotrowski ZH, Nelson MR et al. Effect of a statewide neonatal resuscitation training program on Apgar scores among high-risk neonates in Illinois. Pediatrics 2001; 107: 648-655
  • 42 Patel J, Posencheg M, Ades A. Proficiency and retention of neonatal resuscitation skills by pediatric residents. Pediatrics 2012; 130: 515-521
  • 43 Perlman JM, Wyllie J, Kattwinkel J et al. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122: S516-S538
  • 44 Roy KM, Miller MP, Schmidt K et al. Pediatric residents experience a significant decline in their response capabilities to simulated life-threatening events as their training frequency in cardiopulmonary resuscitation decreases. Pediatr Crit Care Med 2011; 12: e141-e144
  • 45 Scheuchenegger A, Lechner E, Wiesinger-Eidenberger G et al. Short-term morbidities of moderate and late preterm infants. Klin Padiatr 2013; [Epub ahead of print]
  • 46 Schmölzer GM, Roehr CC. Use of respiratory function monitors during simulated neonatal resuscitation. Klin Padiatr 2011; 223: 261-266
  • 47 Schroedl CJ, Corbridge TC, Cohen ER et al. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial. J Crit Care 2012; 27: 219. e7-219.e13
  • 48 Schwid HA, O’Donnell D. Anesthesiologists’ management of simulated critical incidents. Anesthesiology 1992; 76: 495-501
  • 49 Segen JC. Concise dictionary of modern medicine. 1st ed. The McGraw-Hill Companies Inc.; New York: 2006
  • 50 Soar J, Monsieurs KG, Ballance JH et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010; 81: 1434-1444
  • 51 Stichtenoth G, Demmert M, Bohnhorst B et al. Major contributors to hospital mortality in very-low-birth-weight infants: data of the birth year 2010 cohort of the German Neonatal Network. Klin Padiatr 2012; 224: 276-281
  • 52 Thomas EJ, Taggart B, Crandell S et al. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol 2007; 27: 409-414
  • 53 Thomas EJ, Williams AL, Reichman EF et al. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics 2010; 125: 539-546
  • 54 Turner NM, Lukkassen I, Bakker N et al. The effect of the APLS-course on self-efficacy and its relationship to behavioural decisions in paediatric resuscitation. Resuscitation 2009; 80: 913-918
  • 55 Wayne DB, Siddall VJ, Butter J et al. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Acad Med 2006; 81: S9-S12
  • 56 Weinberg ER, Auerbach MA, Shah NB. The use of simulation for pediatric training and assessment. Curr Opin Pediatr 2009; 21: 282-287
  • 57 Weiner GM, Menghini K, Zaichkin J et al. Self-directed versus traditional classroom training for neonatal resuscitation. Pediatrics 2011; 127: 713-719
  • 58 Weinstock PH, Kappus LJ, Kleinman ME et al. Toward a new paradigm in hospital-based pediatric education: the development of an onsite simulator program. Pediatr Crit Care Med 2005; 6: 635-641
  • 59 Yee B, Naik VN, Joo HS et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology 2005; 103: 241-248