How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation

Joanna C Haynes; Siren I Rettedal; Anastasia Ushakova; Jeffrey M Perlman; Hege L Ersdal

doi:10.1097/SIH.0000000000000783

How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation

Simul Healthc. 2024 Mar 6. doi: 10.1097/SIH.0000000000000783. Online ahead of print.

Authors

Joanna C Haynes¹, Siren I Rettedal, Anastasia Ushakova, Jeffrey M Perlman, Hege L Ersdal

Affiliation

¹ From the Department of Anaesthesia (J.C.H., H.L.E.), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences (J.C.H., S.I.R., H.L.E.), University of Stavanger, Stavanger, Norway; Department of Paediatrics (S.I.R.), Stavanger University Hospital, Stavanger, Norway; Department of Biostatistics (A.U.), Stavanger University Hospital, Stavanger, Norway; and Department of Pediatrics (J.M.P.), Weill Cornell Medicine, New York, NY.

PMID: 38445834
DOI: 10.1097/SIH.0000000000000783

Abstract

Introduction: Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level.

Methods: Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes.

Results: A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent.

Conclusions: Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.