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This study compared the effectiveness of two booster strategies designed to improve retention of skills and knowledge in neonatal resuscitation by family practice residents.
Residents were randomly allocated to one of three groups: video, hands on, or control. Residents in the two experimental groups received a "booster" 3-5 months after the Neonat...
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Citations
... However, clinical simulation-based training is known to improve learners' initial performance; however, skills deteriorate signi cantly after six months [21][22]. In this sense, a study by Hu et al. showed that coupling the use of a serious game improves knowledge retention in students' short-term memory [23]. ...
BACKGROUND: In recent years, medical education has increasingly embraced gamification as a method for teaching clinical skills. In Peru, social isolation resulting from the COVID-19 pandemic forced universities and academic institutions to restructure their teaching methods. Therefore, this work aims to determine whether a game-based strategy is associated with the achievement of clinical skills of students from a Peruvian medical school.
METHOD: We conducted a retrospective and cross-sectional study on medical students’ users of the Full Code Medical Simulation platform. We retrieved qualification data from selected cases of clinical courses with an appropriate number of users [Clinical Medicine (CM) I (7 cases), CM II (17 cases), Surgery I (6 cases) and Surgery II (6 cases). cases)]. We also evaluate correlation between academic performance levels and quantitative variables obtained in the Full Code platform were determined using the Kruskal-Wallis test.
RESULTS: A total of 590 students were enrolled. We found a direct correlation between the student's course grade and Full Code score in all courses (CM I: p<0.001, CM II: p<0.05, Surgery I: p<0.05 and Surgery II: p < 0.05). CM II course students who dedicated more time to case development received better grades (p < 0.05). There was no relationship between the percentage of correctly diagnosed cases and having better grades.
CONCLUSION:The use of gamification in clinical simulation positively influenced the learning outcomes of students in clinical courses. However, the guidance and commitment of the teachers were crucial to motivate and improve the skills of the students.
... While some studies found that a repetition soon after initial teaching was more effective, others found that delayed repetition was more effective for long-term skill retention. 18,19 Though there has yet to be consensus as to the optimal timing of booster sessions for CPR skill retention among healthcare professionals, literature from other fields suggests this value may be 10-30% of the number of days between the initial training and retention test. 20 We aimed to determine the optimal timing of booster sessions for CPR skill retention after completion of a BLS course, with sessions offered at two different timepoints within this suggested interval (i.e., 10-30%). ...
Introduction:
Booster sessions can improve cardiopulmonary resuscitation (CPR) skill retention among healthcare providers; however, the optimal timing of these sessions is unknown. This study aimed to explore differences in skill retention based on booster session timing.
Methods:
After ethics approval, healthcare providers who completed an initial CPR training course were randomly assigned to either an early booster, late booster, or no booster group. Participants' mean resuscitation scores, time to initiate compressions, and time to successfully provide defibrillation were assessed immediately post-course and four months later using linear mixed models.
Results:
Seventy-three healthcare professionals were included in the analysis. There were no significant differences by randomization in the immediate post-test (9.7, 9.2, 8.9) or retention test (10.2, 9.8, and 9.5) resuscitation scores. No significant effects were observed for time to compression. Post-test time to defibrillation (mean ± SE: 112.8 ± 3.0 sec) was significantly faster compared to retention (mean ± SE: 120.4 ± 2.7 sec) (p = 0.04); however, the effect did not vary by randomization.
Conclusion:
No difference was observed in resuscitation skill retention between the early, late, and no booster groups. More research is needed to determine the aspects of a booster session beyond timing that contribute to skill retention.
... [6] It has also been reported that motor skills deteriorate more rapidly than theoretical knowledge. [13] These issues are concerning as high-quality CPR has been proven to improve patient outcomes, especially following an in-hospital cardiopulmonary arrest. The motor skills acquired by CPR training are the essence of providing good quality CPR, in addition to early recognition of cardiopulmonary arrest, initiation of CPR, defibrillation where indicated and administration of applicable drugs. ...
Background
Cardiopulmonary resuscitation (CPR) improves immediate survival and survival to discharge in patients with cardiac arrest in hospital. Without frequent retraining in CPR, healthcare providers may lose their skills and knowledge earlier than the recommendation of CPR retraining every two years.
Objectives
To determine the competencies of doctors at an academic hospital regarding CPR training, knowledge, experience and perceptions.
Methods
A custom-designed questionnaire reviewed by CPR providers was distributed to doctors to obtain information on CPR training, exposure to and perceptions of CPR retraining, and CPR knowledge. The knowledge component of the questionnaire comprised questions on basic, advanced cardiac, paediatric, neonatal and obstetric life support.
Results
Of the 245 participants, 22.5% achieved competency (a mark of ≥ 80%) for the knowledge component of the questionnaire. The majority of participants had not undertaken retraining after two years, although 96.7% of participants felt that keeping up-to-date with CPR guidelines would improve patient outcomes. The most common reasons provided for not feeling confident in performing CPR were related to training.
Conclusion
Doctors at the academic hospital in this study are currently not adequately trained in CPR, which is reflected by their lack of CPR knowledge. Lack of training seems to be the most common reason for not feeling confident, and being too busy to attend these retraining courses was reported as the most common reason. It further seems that very few of the departments have CPR training for their doctors. A regular in-hospital CPR training program may improve doctor's CPR knowledge.
... The participants could easily understand both the languages. 11,[12][13][14][15][16][17] Several studies in high-income and low-income countries have shown that resuscitation knowledge and skills improve immediately following training, however, these resuscitation skills tend to deteriorate over a period of time. 11,[12][13][14][15][16][17] Therefore, neonatal resuscitation training in itself is not an effective implementation strategy to retain resuscitation skills. ...
... 11,[12][13][14][15][16][17] Several studies in high-income and low-income countries have shown that resuscitation knowledge and skills improve immediately following training, however, these resuscitation skills tend to deteriorate over a period of time. 11,[12][13][14][15][16][17] Therefore, neonatal resuscitation training in itself is not an effective implementation strategy to retain resuscitation skills. Similar to our findings from this study, a study done in Canada has shown that the review of schematic posters on neonatal resuscitation before or after resuscitation of babies is not an effective strategy for retention of neonatal resuscitation skills. ...
Introduction: Neonatal death is an emerging challenge and a basic neonatal resuscitation within the first few minutes of life can substantially prevent neonatal mortality. Aims: To reduce neonatal mortality from birth asphyxia and development of the low cost neonatal neonatal resuscitation tool. Methods: The educational effectiveness of helping baby breathe training on newborn simulator, knowledge of trainees from Doctors, Nurses and Medical Students was evaluated before and after training on 19th & 20th November 2021, 10th & 11th December 2021 and 6th & 7th January 2022 respectively. A post course practical skills evaluation was performed on a Neonatalie Newborn Simulator. Participants underwent a two days training course of five hours each day. Results: Seventy eight participants had completed the course. The percentage of correct answers on a written test significantly increased from 82% to 99% after training. 100% of the trainees achieved passing scores. Conclusion: The trainees who participate in helping baby breathe training can significantly improve their knowledge and skills on simulators.
... It is unrealistic to assume that providers' behaviors, that developed during years of service tenure, will be changed in terms of adherence to practices with only capacity building and a few mentoring and support visits. Studies have demonstrated waning knowledge retention by 6 months following completion of the neonatal resuscitation program course [34,35]. Continuous handholding seems to pave the way for positive outcomes during the course of Dakshata implementation. ...
Background
In spite of considerable improvement in maternal and neonatal outcomes over the past decade in India, the current maternal mortality ratio and neonatal mortality rate are far from the Sustainable Development Goal targets due to suboptimal quality of maternity care. A package of interventions for improving quality of intrapartum and immediate postpartum care was co-designed with the Ministry of Health as the Dakshata program and implemented in public sector health facilities in selected districts in the state of Rajasthan of India since June 2015. This article describes the key strategies, interventions, results and challenges from four years of Dakshata program implementation.
Methods
We have conducted secondary analysis of program data (government data) collected from 202 public facilities across 20 districts of Rajasthan state. The data collected between June–August 2015 (baseline) and the data collected between May-August 2019 (latest) were analyzed. The data sources included: facility assessments, service statistics, monthly progress reports.
Results
During the period of program implementation, there were 17,94,249 deliveries accounting for 70% of institutional deliveries in intervention districts. As a result of the intervention, there was a notable increase in competency of health care providers, availability of essential resources, achievement of labour room standards and adherence to evidence-based clinical standards. We also observed reductions in the proportion of referrals for pre-eclampsia/eclampsia, postpartum hemorrhage and neonatal asphyxia by 11, 8 and 3 percentage points respectively. Similarly, data revealed a reduction in stillbirth rates in Dakshata intervention facilities (19.3 vs 15.3) compared to non-Dakshata facilities (21.8 vs 18).
Conclusions
Our experience and findings indicate that the quality of intrapartum and immediate postpartum care can be improved in low- and middle-income countries with the approach presented in this paper.
... More recently, Finan et al. compared the effects of HFS versus LFS in a randomized trial of sixteen neonatal fellows and found no difference in stress measures between the two modalities [21]. Regarding the retention of the learned skills in simulation-based training, studies have shown degradation of the technical skills acquired in certification courses by health professionals over time, which can have significant effects on patient outcomes [19,[22][23][24][25]. ...
Background
Mounting evidence supports the effective acquisition of skills through simulation-based training including intubation skills of neonates. Our aim is to compare the effect of using high- versus low-fidelity mannequin simulation-based training on the acquisition and retention of neonatal intubation skills by junior pediatric residents.
Methods
Randomized controlled trial involving first- and second-year pediatric residents from two centers in Jeddah, Saudi Arabia.
Results
Twenty-eight junior pediatric residents (12 low- and 16 high-fidelity mannequins) completed the study. A significantly greater number of residents achieved and retained the required skills after completing the training course in both arms. There was no significant difference in the achieved skills between residents trained on high- versus low-fidelity mannequins at the baseline, immediately after training, and at 6–9 months after training.
Conclusion
Simulation-based training resulted in improving pediatric residents’ intubation skills regardless of the level of fidelity.
... A significant shift toward more rationale resuscitation practices was indicated by a decline in the use of chest compression and medication (p < 0.001 for each), and an increase in the use of bag and mask ventilation [17]. Knowledge retention often does not decline at the rate that practical skill retention declines, indicating that birth attendants need continuous refresher training that focus on practical skills [18]. ...
... is has been evidenced by the fact that practical skill retention declines at a higher rate than knowledge retention, and birth attendants often face challenges with the application of their skills during real scenarios [18]. Neonatal deaths occur during delivery because of lack of proper resuscitation management. is situation is mostly associated with the skill gap of health professionals. ...
... In the current study, there were significant improvements on the following aspects of appropriate decisions and actions for neonatal resuscitation: determination of APGAR score is the first step in neonatal resuscitation, hydrocortisone injection is important in neonatal resuscitation, one pre-warmed towel is adequate for neonatal resuscitation, and when co-coordinating ventilation and chest compression one session of ventilation is done after every 3 chest compressions (p < 0.001). ese findings were similar with studies conducted in neonatal resuscitation training with simulators [6,7,13,17,18,22,24,27,29,30]. e scientific explanation behind it was the current study, and all these studies advocated that healthcare providers and students should focus their education on areas of theoretical background plus skill laboratory training with simulators specially with high fidelity simulators. ...
Background:
Nearly one in five hundred babies unexpectedly need resuscitation at birth, and the need for resuscitation is often unpredictable. A large majority of these deaths occur in low-resource settings and are preventable. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Therefore, producing skilled health professionals in teaching institutions is mandatory to perform this activity.
Objective:
The study aimed a pre- and post-evaluation of knowledge and clinical skills performance of anesthesia students completing simulation-based neonatal resuscitation training at a Teaching Referral Hospital.
Methods:
A pre-post-intervention study was conducted on undergraduate final-year anesthesia students at Comprehensive and Specialized Teaching Referral Hospital, Ethiopia. We used a validated checklist to follow the students' performance (American Heart Association, 2005, and Ogunlesi et al., 2012). The data were collected through this checklist. The collected data were analyzed with statistical package for social sciences (SPSS) version 20. Categorical variables were analyzed with chi-square test, and a p-value <0.05 was considered as statistically significant.
Results:
A total of 51 students participated in the study. Twenty of them were females. The pre-intervention knowledge of the respondents about aspects of evaluation for neonatal resuscitation was 90.2%, and post-intervention was 94.1%; the knowledge of the respondents about aspects of appropriate actions at pre- and post-interventions was 73.4% and 83.1%, respectively. Conclusions and recommendations: This study showed that there was improvement of post-interventions knowledge and clinical skills of undergraduate anesthesia students for both aspects of evaluation and appropriate actions for neonatal resuscitation. We recommend that students who attached clinical anesthesia practice should take at least simulation-based training at skill laboratories timely.
... The second component, the "Quick Reference" section, provided information on calculations and a faster access to videos and images from the first section. Kawzorowski et al. used two "booster" interventions [17]. The video booster, an e-learning strategy, included a video review of NRP paired with unsupervised mannequin practice. ...
Objective
To determine if e-learning interventions are efficient to review Neonatal Resuscitation Program (NRP) and to prevent performance deterioration in neonatal resuscitation of already-certified healthcare professionals.
Study design
In this scoping review, we searched for manuscripts published until June 2020 in five databases. We included all studies on e-learning use for NRP review in already-certified healthcare providers.
Results
Among 593 abstracts retrieved, 38 full-text articles were assessed for eligibility. Five studies were included. Four studies evaluated the effectiveness of e-learning interventions immediately or months after their completion by providers. These interventions did not consistently enhance their NRP knowledge and their performance. One study showed that a growth mindset can influence positively neonatal resuscitation performance after an e-learning simulation.
Conclusion
There is not enough evidence to conclude that e-learning interventions can prevent neonatal resuscitation knowledge and performance decay in already-certified providers. More research is needed on the use of e-learning simulation-based scenarios to improve NRP retention.
... Similar results were noticed in a study conducted to assess the knowledge retention on community maternal and newborn health among frontline health workers in rural Ethiopia at the 18-month follow-up (Gobezayehu AG, et al., 2014). Some other studies also demonstrated a sustained level of knowledge retention months after the training (Malau-Aduli BS, et al., 2019; Sankar J, et al., 2013), followed by a gradual decline (Kaczorowski J, et al., 1998;Carlo WA, et al., 2009). In a study among pre-service and in-service nurses, it was seen that the acquisition of knowledge and skills improved with training in both pre-service and in-service nurses. ...
... The study also emphasized the role of assessments in evaluating the relevance of the course structure and assisting in benchmarking knowledge retention, and comparing results of the evaluation (Malau-Aduli BS, et al., 2019). In terms of decline in knowledge, it was seen in a study conducted among residents that a deterioration in both neonatal skills and knowledge was observed, which did not show any improvement when the training was supplemented with the use of mannequins of booster videos on the training topics (Kaczorowski J, et al., 1998). In another study conducted among nurses on neonatal resuscitation programs, it was seen that training led to a substantial improvement and enhancement of knowledge and skills of neonatal resuscitation. ...
... Bender showed that a booster session 9 months after Neonatal Resuscitation Program (NRP) training improved performance among residents at 15 months, compared to no booster [15]. However, Kaczorowski found that family practice residents who received a booster at 3-5 months after NRP training had no improvement in skill retention at 6-8 months, compared to no booster [16]. These studies all provided a booster months after initial teaching. ...
... This study was a prospective, single-blind randomized controlled trial based on simulation. We obtained ethical approval from the Ottawa Health Science Network Research Ethics Board (Protocol #: 20150174-01H) and the University of Ottawa (H11- [16][17][18][19][20][21][22]. This paper adheres to the CON-SORT reporting guidelines and the extensions for healthcare simulation research [25,26]. ...
Purpose:
Retention of skills and knowledge has been shown to be poor after resuscitation training. The effect of a "booster" is controversial and may depend on its timing. We compared the effectiveness of an early versus late booster session after Basic Life Support (BLS) training for skill retention at 4 months.
Methods:
We performed a single-blind randomized controlled trial in a simulation environment. Eligible participants were adult laypeople with no BLS training or practice in the 6 months prior to the study. We provided participants with formal BLS training followed by an immediate BLS skills post-test. We then randomized participants to one of three groups: control, early booster, or late booster. Based on their group allocation, participants attended a brief BLS refresher at either 3 weeks after training (early booster), at 2 months after training (late booster), or not at all (control). All participants underwent a BLS skills retention test at 4 months. We measured BLS skill performance according to the Heart and Stroke Foundation's skills testing checklist for adult CPR and the use of an automated external defibrillator.
Results:
A total of 80 laypeople were included in the analysis (control group, n = 28; early booster group, n = 23; late booster group, n = 29). The late booster group achieved better skill retention (mean difference in checklist score at retention compared to the immediate post-test = - 0.8 points out of 15, [95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6, 0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001).
Conclusion:
A late booster session improves BLS skill retention at 4 months in laypeople.
Trial registration number:
NCT02998723.
