title: Deliberate practice using simulation improves neonatal resuscitation performance.
abstract: BACKGROUND
  Simulation will soon become the standard method of training in the Neonatal Resuscitation Program (NRP). Deliberate practice (DP) using simulation has been shown to improve performance in other areas of medicine. The objective of this study was to evaluate the effectiveness of DP using simulation on improving NRP performance.
  
  
  METHODS
  Using a pretest-posttest design, 15 teams of 2 residents participated in a series of 3 NRP simulations followed by a facilitated debriefing. Objective measures of NRP performance and time to complete critical tasks were evaluated on the first (pretest) and the third (posttest) simulations by blinded video review using a validated scoring instrument.
  
  
  RESULTS
  Improvements were seen in scores for overall NRP performance (pretest 82.5% vs. posttest 92.5%, mean difference 10% [95% CI, 1.5-18.5]; P = 0.024) and positive-pressure ventilation (pretest 73.3% vs. posttest 95.0%, mean difference 21.7% [95% CI, 0.8-42.5]; P = 0.043). Time to the vascular access decreased by over 1 minute from baseline (pretest 404 second vs. posttest 343 second, mean difference -60.3 second [95% CI, -119.6 to -0.9]; P = 0.047) as did the time to first IV medication (pretest 452 second vs. posttest 387 second, mean difference -64.9 second [95% CI, -112.4 to -17.5]; P = 0.011).
  
  
  CONCLUSIONS
  Our results suggest that DP using simulation is associated with improvements in NRP performance and support the use of DP using simulation in NRP training.
authors.affiliation: Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA. taylor.l.sawyer@us.army.mil
authors.forename: Taylor
authors.initials: T
authors.lastname: Sawyer
authors.forename: Agnes
authors.initials: A
authors.lastname: Sierocka-Castaneda
authors.forename: Debora
authors.initials: D
authors.lastname: Chan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berg
authors.forename: Mike
authors.initials: M
authors.lastname: Lustik
authors.forename: Mark
authors.initials: M
authors.lastname: Thompson
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training / Q000379:methods*; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008348:Manikins; D015397:Program Evaluation; D014584:User-Computer Interface