1. Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. Deliberate Practice Using Simulation Improves Neonatal Resuscitation Performance. Simulation in Healthcare 2011; 6(6):327-36 2. Ericsson, KA. Deliberate Practice and the Acquisition and Maintenance of Expert Performance in Medicine and Related Domains. Academic Medicine 2004; 79 (10):S70-81 3. American Academy of Pediatrics and American Heart Association. Neonatal Resuscitation Program (NRP) Textbook - 6th Edition. May 2011 4. Ericsson, KA. Deliberate Practice and Acquisition of Expert Performance: A General Overview. Academic Emergency Medicine 2008; 15:988-994 5. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. 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 Jun; 86(6):706-11 6. Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Pediatric resident resuscitation skills improve after “Rapid Cycle Deliberate Practice” training. Resuscitation 2014Mar 4 pii: S0300-9572(14)0011504 [epub ahead of print] 7. Campbell DM, Barozzino T, Farrugia M, Sgro M. High-fidelity simulation in neonatal resuscitation. Pediatric Child Health 2009; 14:19-23

Evaluate the effectiveness of Rapid Cycle Deliberate Practice as a simulation based teaching methodology versus traditional simulation based education during Neonatal Resuscitation education.

Hypothesis: The standard curriculum for how to stabilize and resuscitate newborns in the delivery room is adherence to the Neonatal Resuscitation Program (NRP), a simulation-based team training program, although the curriculum is standardized, the most optimal debriefing techniques for optimal learning are still understudied. It is in the debriefing process where learning occurs. The current traditional method involves running a simulated scenario immediately followed by an NRP instructor led debriefing session with or without video review. The novel method of Rapid-Cycle Deliberate Practice (RCDP) evaluates an alternative debriefing methodology, RCDP- a simulation-based train-to-mastery form of debriefing education (1,2). Our hypothesis is that RCDP is a more effective tool for debriefing than traditional during NRP training. Methods: During each NRP session, learners will be assigned using the standard NRP multidisciplinary team recommendations into four teams prior to randomization into 2 groups receiving RCDP (intervention) and 2 groups receiving traditional (control) debriefing. All teams will receive the same 3 scenarios during NRP. RCDP utilizes interrupted, immediate feedback during the first two scenarios while traditional groups complete the entire scenarios without interruption, followed by debriefing after completion. The third scenario will be debriefed traditionally for all groups and video reviewed for comparison analysis. Results: Full results pending, however there will be 25 groups video-reviewed: 13 RCDP and 12 Traditional groups. They will be scored using a modified Neonatal Resuscitation Performance Evaluation (NRPE) tool as well as timing of active skills including: intubation, chest compression and UVC placement (1). Results of the NRPE will compare control vs. study group’s performance in and adherence to the Neonatal Resuscitation Program. Discussion : Given that this is a required training program for any clinician taking care of babies in the delivery room, identifying the most optimal training methodology is critical. Worldwide, skillful resuscitation of newborns in the delivery room could save over 1 million babies’ lives each year. Simulation Based Medical Education has become the standard technique for Neonatal Resuscitation Programs (3). With Rapid Cycle Deliberate Practice, the overall goal is that by having learners repeat multiple scenarios with high fidelity simulation there will be an improvement in advanced resuscitation skills (1,7). Simulation has already been proven to be a better training methodology as compared to other traditional education methods. Now this study will start to valuate innovative simulation methodology. Results of team performance from video review will be available at the time of presentation

Survey comments received from participants: Positive toward RCDP: Ø “The Rapid-Cycle was great – the most I’ve gotten out of any Sim” Ø “The new method really reflected after the final simulation in which I felt we performed wonderfully as a team” Ø “I think the rapid sequence techniques is more helpful because it provided immediate feedback and what we can improve on “ Room for improvement: Ø “Hard to start back over on the rapid training but effect, learn things faster” Ø “RCDP is very tiring”

Abstract Results

Objectives

Conclusions

References

Study Design

Outcome Comparison: Performance of teams control vs. intervention groups compared using the modified NRPE tool [3] Modified Neonatal Resuscitation Program Evaluation (NRPE): - Components of set-up/preparation - Airway/Intubation - Chest Compression - Lines Placement Video Review: Blinded, trained neonatology faculty reviewed team performance using NRPE (1 Video removed from data secondary to technical difficulties prohibiting review)

25 Multidisciplinary Participant Groups

(Control: 12 Intervention: 13)

Intro to Simulation & NRP Skills stations – 2 hours

Control Group: Traditional 1) Simulation scenario #1: 15 min + Debrief 25 min (40 min) 2) Simulation scenario #2: 20 min + Debrief 30 min (50 min)

Post Test Simulation (all groups)

Scenario: 20 min Debrief: 10 min Total Time: 2 hrs

Intervention group: RCDP 1) RCDP Scenario w/ Debriefing

#1: 40 min 2) RCDP Scenario w/ Debriefing

#2: 50 min

Traditional Method

Improved Future Performance

Scripted Advocacy & Inquiry Debriefing

Simulated Performance

Novice performance

Brief feedback

Competent performance

More feedback

Mastery performance

Increased difficulty

RCDP Model

Curriculum Development

The same clinical content was developed for both RCDP and traditional simulation scenarios. The 2 sets of RCDP scenarios were written with advancing difficulty that were tested by master learners prior to implementation in multi-disciplinary teams. Traditional scenarios were written using our institution’s traditional scenario design format. Clinical content & learning objectives of cases for RCDP and traditional were the same. Testing Scenario (Traditional format): -Full term newborn with shoulder dystocia with cardiac arrest requiring airway management, CPR, umbilical venous catheter (UVC) line placement, and medication resuscitation Teaching Scenarios (RCDP and Traditional): -Full term newborn with initial resuscitation requiring airway management -Full term newborn with placental abruption with hypovolemic cardiac arrest requiring airway management, CPR, UVC line placement, and medication/volume resuscitation RCDP Scenario Rounds: Each round increased number and complexity of interventions that needed to be completed. If not performed correctly, instructor would provide feedback and allow team to try again. If all required interventions performed correctly, the patient would improve and positive feedback would be given.

Example: RCDP Round Expected Actions for Placental Abruption

1.  Team prepares for delivery and roles assigned 2.  Team provides dry, stimulation, & suction 3.  Team provides effective PPV 4.  Team evaluates respiratory support and performs

MR.SOPA 5.  Team performs intubation 6.  Team performs effective chest compressions 7.  Team obtains UVC placement 8.  Team administers epinephrine and pRBC transfusion

Funding and Thank Yous This work was made possible by the Evangeline “Evie” Whitlock Grant through the Neonatology Department at Texas Children’s Hospital and the Texas Children’s Hospital Simulation Center Contact for more information: kepatric@bcm.edu

•  RCDP is a feasible means to provide instruction to multi-disciplinary learners

•  This method was accepted by these teams to reinforce their knowledge about resuscitation of critically ill infants.

•  Our sample size may have been too small to show effect of timing differences

•  Further research is necessary to determine if RCDP helps to promote long-term memory and increases knowledge retention time

8th International Pediatric Simulation Symposium and Workshops 2016

9-11 May, Glasgow, UK

A Cluster-Randomized, controlled trial of Rapid-Cycle Deliberate Practice Simulation versus Traditional Debriefing of Neonatal Resuscitation Program

Karen E Patricia MD, Dan Lemke MD, Jennifer Arnold MD, MSc Baylor College of Medicine/Texas Children’s Hospital

PO.ID 03-3

Demographics RCDP Teams Traditional Teams P-Value

Position Title: -  Attending -  Fellow -  NP -  Nurse -  RT -  Resident

3 (4.2%) 4 (5.7%) 3 (4.3%) 41 (58.8%) 5 (7.1%) 14 (20%)

3 (5.2%) 0 (0%) 1 (1.7%) 40 (69%) 3 (5.2%) 11 (19%)

0.4421

Real Codes (past year) -  0 -  1 to 2 -  3 to 5 -  5 to 10 -  >10

26 (37.1%) 17 (24.3%) 14 (20%) 6 (8.6%) 7 (10%)

16 (27.6%) 19 (32.8%) 12 (20.7%) 5 (8.6%) 6 (10.3%)

0.5129

Key: N=128 except P-values based upon Chi-Squared test Groups were similar in comparison to Simulation experience with Real Life experience involving PALS, NRP and procedural training

Measurement ICC (95% CI) Interpretation Overall Score – NRPE 0.455 (0.078, 0.720) Fair to Good Time to First Adequate BMV/PPV 0.612 (0.273, 0.817) Excellent

Time to First Chest Compression 0.999 (0.998, 1.000) Excellent

Time to Successful Intubation 0.962 (0.915, 0.983) Excellent

Time to First Epi Dose 0.950 (0.885, 0.979) Excellent Time to Vascular Access 0.996 (0.989, 0.998) Excellent

0

5

10

15

20

25

30

RCDP Traditional

Modified NRPE Score

0 100 200 300 400 500 600

First Adequate PPV

First Chest Compression

Successful Intubation

First Epinephrine

Line Access

Total Resuscitation Time

Average Time to Completion of Major Resuscitation Components (in Seconds)

Traditional

RCDP