Health Care Providers' Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study.

BACKGROUND: Neonatal resuscitation involves a complex sequence of actions to establish an infant's cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners' attitudes toward computer-based learning and assessment environments influence their performance. OBJECTIVE: This study explores the relation between HCPs' attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. METHODS: Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants' survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. RESULTS: The results revealed that mindset moderated the relation between participants' perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=-1.19, SE=0.38, t44=-3.12, 95% CI -1.96 to -0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=-1.21, SE=0.38, t44=-3.16, 95% CI -1.99 to -0.44; P=.003). CONCLUSIONS: Mindset moderates the strength of the relationship between HCPs' perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks.

Effect of monitor positioning on visual attention and situation awareness during neonatal resuscitation: a randomised simulation study.

OBJECTIVES: To compare situation awareness (SA), visual attention (VA) and protocol adherence in simulated neonatal resuscitations using two different monitor positions. DESIGN: Randomised controlled simulation study. SETTINGS: Simulation lab at the Royal Alexandra Hospital, Edmonton, Canada. PARTICIPANTS: Healthcare providers (HCPs) with Neonatal Resuscitation Program (NRP) certification within the last 2 years and trained in neonatal endotracheal intubations. INTERVENTION: HCPs were randomised to either central (eye-level on the radiant warmer) or peripheral (above eye-level, wall-mounted) monitor positions. Each led a complex resuscitation with a high-fidelity mannequin and a standardised assistant. To measure SA, situation awareness global assessment tool (SAGAT) was used, where simulations were paused at three predetermined points, with five questions asked each pause. Videos were analysed for SAGAT and adherence to a NRP checklist. Eye-tracking glasses recorded participants' VA. MAIN OUTCOME MEASURE: The main outcome was SA as measured by composite SAGAT score. Secondary outcomes included VA and adherence to NRP checklist. RESULTS: Thirty simulations were performed; 29 were completed per protocol and analysed. Twenty-two eye-tracking recordings were of sufficient quality and analysed. Median composite SAGAT was 11.5/15 central versus 11/15 peripheral, p=0.56. Checklist scores 46/50 central versus 46/50 peripheral, p=0.75. Most VA was directed at the mannequin (30.6% central vs 34.1% peripheral, p=0.76), and the monitor (28.7% central vs 20.5% peripheral, p=0.06). CONCLUSIONS: Simulation, SAGAT and eye-tracking can be used to evaluate human factors of neonatal resuscitation. During simulated neonatal resuscitation, monitor position did not affect SA, VA or protocol adherence.

RETAIN: A Board Game That Improves Neonatal Resuscitation Knowledge Retention.

Background: The current resuscitation guidelines recommend frequent simulation based medical education (SBME). However, the current SBME approach is expensive, time-intensive, and requires a specialized lab and trained instructors. Hence, it is not offered routinely at all hospitals. We designed the board game "RETAIN" to train healthcare providers (HCPs) in neonatal resuscitation in a cost-friendly and accessible way. Objectives: To examine if a board game-based training simulator improves knowledge retention in HCPs. Methods: "RETAIN" consists of a board using an image of a baby, visual objects, adjustable timer, monitors, and action cards. Neonatal HCPs at the Royal Alexandra Hospital were invited to participate. Participants completed a written pre-test (resuscitation of a 24-week infant), then played the board game (starting with a tutorial followed by free playing of three evidence-based neonatal resuscitation scenarios). Afterwards, a post-test with the same resuscitation scenario and an opinion survey was completed. The answers from the pre- and post-test were compared to assess HCPs' knowledge retention. Results: Thirty HCPs (four doctors, 12 nurses, and 14 respiratory therapist) participated in the study. Overall, we observed a 10% increase in knowledge retention between the pre- and post-test (49-59%, respectively). Temperature management showed the most knowledge gain between the pre- and post-test (14-46%, respectively). Placement of a hat (10-43%), plastic wrap (27-67%), and temperature probe (7-30%) improved between the pre- and post-test. Conclusion: Knowledge retention increased by 12% between pre- and post-test (49-61%, respectively). The improvement in performance and knowledge supports the use of board game simulations for clinical training.

The SURV1VE trial-sustained inflation and chest compression versus 3:1 chest compression-to-ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns: study protocol for a cluster randomized controlled trial.

BACKGROUND: The need for cardiopulmonary resuscitation (CPR) is often unexpected, and the infrequent use of CPR in the delivery room (DR) limits the opportunity to perform rigorous clinical studies to determine the best method for delivering chest compression (CC) to newborn infants. The current neonatal resuscitation guidelines recommend using a coordinated 3:1 compression-to-ventilation (C:V) ratio (CC at a rate of 90/min and ventilations at a rate of 30/min). In comparison, providing CC during a sustained inflation (SI) (CC + SI) significantly improved hemodynamics, minute ventilation, and time to return of spontaneous circulation (ROSC) compared to 3:1 C:V ratio in asphyxiated piglets. Similarly, a small pilot trial in newborn infants showed similar results. Until now no study has examined different CC techniques during neonatal resuscitation in asphyxiated newborn infants in the DR. To date, no trial has been performed to directly compare CC + SI and 3:1 C:V ratio in the DR during CPR of asphyxiated newborn infants. METHODS: This is a large, international, multi-center, prospective, unblinded, cluster randomized controlled trial in asphyxiated newborn infants at birth. All term and preterm infants > 28+ 0 by best obstetrical estimate who require CPR at birth due to bradycardia (< 60/min) or asystole are eligible. The primary outcome of this study is to compare the time to ROSC in infants born > 28+ 0 weeks' gestational age with bradycardia (< 60/min) or asystole immediately after birth who receive either CC + SI or 3:1 C:V ratio as the CPR strategy. DISCUSSION: Morbidity and mortality rates are extremely high for newborns requiring CC. We believe the combination of simultaneous CC and SI during CPR has the potential to significantly improve ROSC and survival. In addition, we believe that CC + SI might improve respiratory and hemodynamic parameters and potentially minimize morbidity and mortality in newborn infants. In addition, this will be the first randomized controlled trial to examine CC in the newborn period. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02858583 . Registered on 8 August 2016.

Growth Mindset Moderates the Effect of the Neonatal Resuscitation Program on Performance in a Computer-Based Game Training Simulation.

This study examines for the first time the moderating role of growth mindset on the association between the time elapsed since participants' last refresher neonatal resuscitation program (NRP) course and their performance on neonatal resuscitation tasks in the RETAIN computer game training simulation. Participants were n = 50 health-care providers affiliated with a large university hospital. Results revealed that growth mindset moderated the relation between participants' task performance in the game and the time since their latest refresher NRP course. Specifically, participants who completed the course more recently (i.e., between 8 and 9 months before the current study) made significantly more mistakes in the game than the rest of the participants but only when they endorsed lower levels of growth mindset. Implications of this research include growth mindset interventions and increased screen time in simulation sessions that have the potential to help health-care providers achieve better performance on neonatal resuscitation clinical tasks.

Ventilation Strategies during Neonatal Cardiopulmonary Resuscitation.

Approximately, 10-20% of newborns require breathing assistance at birth, which remains the cornerstone of neonatal resuscitation. Fortunately, the need for chest compression (CC) or medications in the delivery room (DR) is rare. About 0.1% of term infants and up to 15% of preterm infants receive these interventions, this will result in approximately one million newborn deaths annually worldwide. In addition, CC or medications (epinephrine) are more frequent in the preterm population (~15%) due to birth asphyxia. A recent study reported that only 6 per 10,000 infants received epinephrine in the DR. Further, the study reported that infants receiving epinephrine during resuscitation had a high incidence of mortality (41%) and short-term neurologic morbidity (57% hypoxic-ischemic encephalopathy and seizures). A recent review of newborns who received prolonged CC and epinephrine but had no signs of life at 10 min following birth noted 83% mortality, with 93% of survivors suffering moderate-to-severe disability. The poor prognosis associated with receiving CC alone or with medications in the DR raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes.

Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial.

BACKGROUND: Current neonatal resuscitation guidelines recommend 3:1 compression:ventilation (C:V) ratio. Recently, animal studies reported that continuous chest compressions (CC) during a sustained inflation (SI) significantly improved return of spontaneous circulation (ROSC). The approach of CC during SI (CC+SI) has not been examined in the delivery room during neonatal resuscitation. HYPOTHESIS: It is a feasibility study to compare CC+SI versus 3:1 C:V ratio during neonatal resuscitation in the delivery room. We hypothesised that during neonatal resuscitation, CC+SI will reduce the time to ROSC. Our aim was to examine if CC+SI reduces ROSC compared with 3:1 C:V CPR in preterm infants <33 weeks of gestation. STUDY DESIGN: Randomised feasibility trial. METHOD: Once CC was indicated all eligible infants were immediately and randomly allocated to either CC+SI group or 3:1 C:V group. A sequentially numbered, brown, sealed envelope contained a folded card box with the treatment allocation was opened by the clinical team at the start of CC. STUDY INTERVENTIONS: Infants in the CC+SI group received CC at a rate of 90/min during an SI with a duration of 20 s (CC+SI). After 20 s, the SI was interrupted for 1 s and the next SI was started for another 20 s until ROSC. Infants in the '3:1 group' received CC using 3:1 C:V ratio until ROSC. PRIMARY OUTCOME: Overall the mean (SD) time to ROSC was significantly shorter in the CC+SI group with 31 (9) s compared with 138 (72) s in the 3:1 C:V group (p=0.011). CONCLUSION: CC+SI is feasible in the delivery room. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT02083705, pre-results.