High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

Abstract

Objective: Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees.Study Design: Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made.Result: The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P ¼ 0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups.Conclusion: Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

“…When inductively searching for conceptual themes shared across studies, we identified 7 studies comparing high with low physical realism simulation as part of the educational intervention, and conducted a metaanalysis pooling the results of these studies. [26][27][28][29][30][31][32] We narratively discuss the other studies with nonrecurrent themes. [33][34][35][36][37][38][39][40][41][42][43] …”

“…Seven studies [26][27][28][29][30][31][32] compared the use of high versus low physical realism simulators for TES as an educational modality (Fig 4). Meta-analysis of these studies revealed pooled effects of small magnitude favoring high physical realism for nontime skills (4 studies; ES = 0.49; P , .001) and learner reactions (3 studies; ES = 0.70; P , .01).…”

Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task

“…17 Our results are similar to those in a crossover study by Finan et al who showed that performing neonatal resuscitation on a full-body infant simulator during a simulated cardiac arrest scenario was not different from performing a verbalized cardiac arrest scenario on a training infant mannequin. 18 A possible explanation for our findings and those of the previous study 18 is that, although the degree of physical fidelity differed between the two scenarios, psychological fidelity may be equally high for both. Psychological fidelity involves the extent to which participants engage in tasks that generate actions and processing demands that are similar to those in the clinical environment.…”

“…In task domains where life and death are at stake, a high degree of psychological fidelity can achieve a level of stress closer to that experienced in the real-life situation. This view is supported by the study of Finan et al 18 who showed that the level of stress cortisol was similarly elevated in both NCS and CS, suggesting that psychological fidelity was high in both scenarios. There is some evidence to suggest that there can be a disconnect between psychological and physical fidelity and that psychological fidelity may be a more important factor in influencing the performance of procedural tasks.…”

Stress management in crisis event simulations for enhancing performance

“…6 A strategy that purports to increase affective realism by using high-fidelity simulation instead of low-fidelity simulation has also been used as an intervention to reduce stress in resuscitation scenarios. 17 It is known that a certain degree of stress during training can improve performance and can decrease performance-related anxiety. However, the study did not demonstrate the effective use of high-fidelity simulation over low-fidelity simulation use in terms of stress modification.…”