Educational Perspectives: Educational Strategies to Improve Outcomes from Neonatal Resuscitation

The Relationship between Pediatric Medical Training and Neonatal Care in the Delivery Room and Beyond

The modern neonate differs greatly from newborns cared for a half-century ago, when the neonatal-perinatal medicine certification examination was first offered by the American Board of Pediatrics. Delivery room resuscitation and neonatal care are constantly evolving, as is the neonatal workforce. Similarly, the Accreditation Council for Graduate Medical Education review committees revise the requirements for graduate medical education programs every 10 years, and the modern pediatric medical trainee is also constantly evolving. Delivery room resuscitation, neonatal care, and pediatric residency training are codependent; changes in one affect the other and subsequently influence neonatal outcomes. In this educational perspective, we explore this relationship and outline strategies to mitigate the impact of decreased residency training in neonatal-perinatal medicine.

Insights from a cross-sectional survey of neonatal resuscitation instructors from India

Neonatal resuscitation training can change outcomes of neonatal mortality due to perinatal asphyxia. Recently, in 2021, the advanced NRP course material was changed, and for Basic NRP, a hybrid course was introduced in India. We assessed the instructor's feedback to improve the conduct of the IAP NNF NRP Program as well as get their perception of the effectiveness, usefulness, and pitfalls of the new hybrid Basic NRP course (offline + online). A cross-sectional survey was conducted amongst instructors across India with current status with IAP NRP FGM Office. The data were exported to a Microsoft Excel Spreadsheet. STATA 14.2 was used for descriptive [Frequency (percent) analysis. 827 basic and 221 advanced NRP instructors responded. Bag and mask ventilation was identified as the most important step in basic 468 (56.6%) and advanced 147 (66.5%) courses. In the basic NRP, almost two third (71.0%) participants believe that it is challenging to conduct a case scenario for bag and mask ventilation, whereas, in the advanced course, intubation 116 (52.5%) was considered the most difficult step to teach and medication 80(36.2%) followed by intubation 62(28.1%) are the most difficult steps to conduct case scenario. 725(87.7%) reported that it would be easy to explain them in an offline course after completion of an online course. Most of the instructors were satisfied with the course structure, material, overall quality of the workshop, and support from the IAP NRP office. Constructive suggestions were obtained from the instructors for improvement of the course.

State-of-the art training in neonatal resuscitation

Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention. In the same manner, as evidence has accumulated to support the guidelines for neonatal resuscitation so, too, has affirmation of training methodologies and technologies. This guarantees that training in neonatal resuscitation will continue to evolve to meet the needs of healthcare professionals charged with caring for newborns at one of the most vulnerable times in their lives.

Learning with digital recording and video review of delivery room resuscitation

Digital recording and video review of delivery room resuscitations is a proven useful tool to evaluate neonatal resuscitation program (NRP) technical and non-technical skills. It is also valuable for research, quality improvement, and individual and group learning. Digital recording and video review programs are growing in number, and planning and implementation of digital recording requires careful thought. Consideration of technology requirements, policy implementation, and stakeholder involvement is essential to implement a successful digital recording and video review program. Video review can then be applied for individual and team-based learning. An approach to sustainability and on-going quality review of the program are key components critical to success.