title: Assessment of neonatal resuscitation skills: a reliable and valid scoring system.
abstract: OBJECTIVE
  To study the reliability and validity of a scoring instrument for the assessment of neonatal resuscitation skills in a training setting.
  
  
  METHODS
  Fourteen paediatric residents performed a neonatal resuscitation on a manikin, while being recorded with a video camera. The videotapes were analysed using an existing scoring instrument with an established face and content validity, adjusted for use in a training setting. Intra- and inter-rater reliability were assessed by comparing the ratings of the videotapes of three raters, one of who rated the videotapes twice. Intra-class coefficients (ICC) were calculated for the sum score, percentages of agreement and kappa coefficients for the individual items. To study construct validity, the performance of a second resuscitation of by residents was assessed after they had received feedback on their first performance.
  
  
  RESULTS
  The ICC were 0.95 and 0.77 for intra- and inter-rater reliability, respectively. The median percentage of intra-rater agreement was 100%; inter-rater agreement 78.6-84.0%. The median kappa was 0.85 for intra-rater reliability, and 0.42-0.59 for inter-rater reliability. Residents showed a 10% improvement (95% confidence interval -4; 23%) on performance of a second resuscitation, which supports the instrument's construct validity.
  
  
  CONCLUSIONS
  A useful and valid instrument with good intra-rater and reasonable inter-rater reliability is now available for the assessment of neonatal resuscitation skills in a training setting. Its reliability can be improved by using a more advanced manikin and by training of the raters.
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Philine A
authors.initials: PA
authors.lastname: van der Heide
authors.forename: Letty
authors.initials: L
authors.lastname: van Toledo-Eppinga
authors.forename: Maaike
authors.initials: M
authors.lastname: van der Heide
authors.forename: Johanna H
authors.initials: JH
authors.lastname: van der Lee
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005240:Feasibility Studies; D030141:Feedback, Psychological; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency; D008348:Manikins; D009359:Neonatology / Q000193:education*; D015203:Reproducibility of Results; D014743:Videotape Recording