Rapid Cycle Deliberate Practice Versus Conventional Simulation for Neonatal Resuscitation Training: A Randomized Controlled Trial

Introduction: Effective neonatal resuscitation at birth is crucial for survival and has the potential to reduce neurodevelopmental morbidities. While traditional simulation-based training in neonatal resuscitation shows greater skill attrition over time, the Rapid Cycle Deliberate Practice (RCDP) approach, a method involving repeated in-simulation practice with immediate feedback, may enhance skill acquisition and retention. However, evidence favoring RCDP in neonatal resuscitation is lacking, particularly in low-income and middle-income countries. Methods: In this randomized trial, pediatric residents (n=39) and nurses (n=9) with prior neonatal resuscitation training within 3 months to 2 years from the date of enrolment participated in simulation-based sessions using either RCDP or conventional simulation and debriefing (CSD). Simulation sessions were conducted utilizing a standardized approach developed by the simulation team. Three simulation scenarios with the same learning objectives were created by the simulation team; minor modifications were made during simulation conduct, assuring that different scenarios were used for training and assessment for the same group. Simulation sessions used for assessment were video recorded, and video raters were blinded to the group allocation. The primary outcome was skill and knowledge retention 1 month after training, assessed using the modified Neonatal Simulation Assessment Score (N-SAS) tool. The secondary outcome was skills and knowledge measured immediately. Performance between RCDP and CSD groups was compared utilizing using the Student t test. Both primary and secondary outcomes were tested in a simulation setting. While long-term retention is of interest, the feasibility of this study only allowed for a 1-month assessment. Results: The mean cumulative N-SAS score 1 month after training was significantly higher in the RCDP group compared with the CSD group [51.8 (4.3) vs. 47.1 (2.4), mean deviation (95% CI): −4.8 (−7.7, −1.8), P =0.003]. Out of the 6 domains in the N-SAS tool, the RCDP group performed better than the CSD group in the preparation domain [20.4 (2.4) versus 18.2 (2.4); mean deviation] (95% CI): −2.3 (−4.3, −0.2), P =0.03]. Regarding secondary outcomes, the RCDP group performed better than the CSD group immediately after training overall, with a statistically significant difference noted in the domains of chest compressions and epinephrine administration. Conclusions: The RCDP compared with the CSD simulation training resulted in improved performance in a simulated setting, as measured by the N-SAS tool, both immediately after the training and 1 month post-training.