526 - Simulating NICU Procedures "Just-in-Time": A Novel Educational Curriculum

The American College of Graduate Medical Education (ACGME) requires that pediatric residents develop competency in common Neonatal Intensive Care Unit (NICU) procedures, but nationally, opportunities to perform these procedures are often limited. Procedure attempts by residents, as opposed to more senior physicians, are also associated with higher complication rates. “Just-in-time” simulations focus on teaching procedural skills immediately before performing a procedure on a patient, and are associated with increased success rates and knowledge retention.

Objective:

This simulation curriculum is a simple, portable, and low-cost pre-procedural simulation that would empower anyone familiar with the procedure to assume a teaching role. We aimed to increase the frequency of pre-procedural teaching in our unit (Rainbow Babies and Children's Hospital NICU) and improve resident procedural confidence.

Design/Methods:

For this project, we developed a standardized pre-procedural simulation kit for three common NICU procedures (intubation, umbilical catheter placement, and lumbar puncture). The kits include low-cost simulation mannequins and cards that contain information on procedural risks, benefits, and how to perform the procedure, which is adapted from MacDonald’s Atlas of Procedures in Neonatology. Providers familiar with the procedures use the cards to guide trainees through a brief simulation session prior to non-emergent procedures. Residents have been completing online surveys used to assess procedural confidence before and after the simulation, and to collect anonymized feedback on the teaching intervention.

Results:

Based on preliminary survey results (n=7, with an eventual goal of 16 responses), there was a statistically significant increase in confidence in performing the procedure after the intervention, with a p-value of 0.014 (using a Wilcoxon signed rank test). There was not a statistically significant difference in confidence in obtaining procedural consent and understanding of procedure risks and complications, likely due to the small sample size, but showed a trend in the positive direction, each with a p-value of 0.157.

Conclusion(s):

"Just-in-time" teaching has been shown to be effective in low-frequency high-risk procedures. This novel curriculum creates a "package" for pre-procedural simulation that includes flash cards and a low-cost simulation mannequin to provide efficient pre-procedural simulation instruction to a resident learner. Survey results demonstrated a statistically significant increase in procedural confidence after using these kits.