Current Practices and Use of Simulation in Neonatal Resuscitation Program Courses Across Canada

Abstract

BACKGROUND: Simulation is an effective tool in medical education. The extent and manner in which simulation is used within Neonatal Resuscitation Program (NRP) courses across Canada is currently unknown. In order to improve NRP education, current practices must be better understood. OBJECTIVES: To characterize current practices and use of simulation in NRP courses across Canada. DESIGN/METHODS: A REDCap survey, consisting of questions about instructor demographics, practices in NRP instruction and use of simulation, was developed and distributed to all NRP instructors across Canada. Simple statistics were used to tabulate responses and the chi-squared test was used to assess differences in simulation use between different types of instructors. RESULTS: Five hundred sixty nine of 1390 (40.9%) NRP instructors completed the survey. Participants included 88 (15.5%) physicians, 74 (13.0%) respiratory therapists, 345 (60.6%) registered nurses and 28 (4.9%) nurse practitioners. Two hundred fifty eight (45.4%) worked in institutions providing Level III care. Overall, 560 (98.4%) respondents used simulation, of which only 176 (31.4%) reported using high-technology simulation. Only 180 (31.6%) instructors who used simulation reported having received formal training in high-technology simulation. When asked about the role of simulation in NRP instruction, 545 (95.8%) agreed or strongly agreed that simulation is a valuable educational tool in NRP instruction, but only 219 (39.1%) felt comfortable using high-technology simulation. There was no difference in use of high-technology simulation between physician and non-physician instructors (I2 0.90, p=0.34). Of the instructors who used high-technology simulation, 160 (90.9%) and 134 (76.1%) had learners and instructors, respectively, from multiple healthcare disciplines present in some or all sessions. There was a non-significant trend towards higher use of interprofessional learners among physician instructors (I2 3.8, p=0.052). An impressive 554 (98.9%) debriefed after some or all simulation sessions, with only 295 (51.8%) instructors having received formal training in debriefing techniques. CONCLUSION: Almost all NRP instructors use simulation and feel that it is valuable, though few have received formal training and feel comfortable using high-technology simulation. Most simulation use is low-technology, in keeping with the Canadian Paediatric Society (CPS) recommendations, though the optimal methods of use of simulation in NRP instruction are not known. The majority of instructors debrief with learners, as recommended by the CPS, though only half have had training in debriefing. The results of this study support further investigation into the optimal type of simulation in NRP teaching and more formal education in simulation and debriefing for NRP instructors.