309 - Ru’ach: Mastery Learning Teletraining to Ensure Effective Ventilation in Neonatal Resuscitation

Poster Number: 309
Publication Number: 309.347

Charles L. Groomes, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Gaithersburg, MD, United States; Min Hwang, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Nora L.. Watson, Walter Reed National Military Medical Center, Chevy Chase, MD, United States; Joseph O.. Lopreiato, Uniformed Services University, Bethesda, MD, United States

Background:
Establishing adequate ventilation is the most effective intervention in neonatal resuscitation; most adverse outcomes result from a failure to do so. Military providers conduct neonatal resuscitations worldwide in low-volume, remote facilities and are at risk of skill attrition in neonatal resuscitation. Simulation-based mastery learning training maintains skill retention in other high-acuity, low-occurrence (HALO) procedures. 


Objective: This study aims to establish the efficacy of a novel, virtually-delivered mastery learning training bundle in maintaining the most critical steps in neonatal resuscitation, ensuring effective ventilation.

Design/Methods: This is a prospective, single-blind, randomized, crossover educational study. Eligible participants are Neonatal Resuscitation Program (NRP) providers at a single military treatment facility. Participants are randomized to crossover sequence 1:1, first receiving either “Usual Training” (Control) or “Mastery Learning Teletraining” (MLTT, Intervention). Usual Training is a brief, self-directed NRP review and equipment familiarization; MLTT is a facilitator-led deliberate practice session focused on effective ventilation (NRP's “MR. SOPA”). In a second session 1-5 months later, participants crossover to receive the alternate training. Following each session, a NRP simulation assessment is conducted. This involves a case of secondary apnea refractory to initial face mask-delivered ventilation. An evaluator (blinded to sequence) then assesses the participants' ability to establish effective ventilation during the assessment (completion of the first five MR. SOPA steps or placement of an advanced airway). Primary outcomes are: (1) establishment of effective ventilation within 3.5 minutes of simulated birth; and (2) time to effective ventilation. For subjects who did not achieve the primary outcome, a secondary outcome is: which MR. SOPA steps were omitted? Planned analyses will address the possible confounding variables of experience, training, and professional role.

Results:

Enrollment is ongoing, with sessions continuing through early 2023. Preliminary data reflect a trend toward intervention-first participants achieving the primary outcome (6/6, 100%), without skill decay in the second assessment. Control-first participants trend toward a lower likelihood of achieving the primary outcome (3/7, 43%).

Conclusion(s):

This study may establish MLTT as an effective, convenient, and inexpensive method to maintain critical NRP skills. MLTT may also improve outcomes in neonatal resuscitation and have applications for skill-sustainment in other HALO procedures.