Helping Babies Breathe: Resident Spotlight at Cincinnati Children’s Hospital Medical Center

Part two of a five part series on the 2014 AAMC Clinical Care Innovation Challenge Pilot Award Winners
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Several years ago in Brazil, medical student Anatalia Labilloy witnessed a newborn die in the delivery room when the care team could not properly perform neonatal resuscitation. The experience left an indelible memory with her. She was early in her medical training and she was anxious about encountering other occasions to resuscitate babies knowing what could happen. Now as a resident at Cincinnati Children’s Hospital Medical Center, Labilloy is practicing vital resuscitation skills to help babies breathe.

Labilloy knows firsthand the value of the simulation-based training she receives to prepare for those rare instances when she will need to provide life-saving resuscitation care. What’s novel about the simulation training at Cincinnati Children’s? The teaching methodology is a competency-based curriculum with simulation to actively engage the learner.

neonatalie
                            NeoNatalie by Laerdal

 

Using NeoNatalie, a low-technology, low-cost plastic mannequin that can mimic crying, spontaneous breathing, and exhibit chest wall movement, residents engage in a more active form of learning by doing with the intent of better attainment, retention of resuscitation skills, and improved patient outcomes.

This pilot research project is supported in part by an AAMC Clinical Care Innovation Challenge Award and a Cincinnati Children’s Perinatal Institute Pilot and Feasibility Grant. Project leaders Beena Kamath-Rayne, MD, MPH and Gary Geis, MD are determining if an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited areas – such as in developing countries – could also improve U.S. pediatric residents’ retention of basic resuscitation skills.

Care Delivery Innovation
The need to practice and retain such skills is critical with changes to duty hours in residency requirements and more limited delivery room experience. Kamath-Rayne says, “Because traditional methods of teaching neonatal resuscitation have not been successful in regards to learner retention, we are using a curriculum based in adult learning theory, which includes more hands-on practice for more active learning, and providing additional opportunities for residents to practice basic resuscitation skills. Our goals are aligned with the AAMC award, to create innovations in clinical care delivery that will improve outcomes, plus improvements in graduate medical education that will advance quality and patient safety. We think this can serve as a model for other pediatric residency training programs and translate into improved delivery room practices.”

The simulation-based training with NeoNatalie is replacing the lost clinical opportunities. “It’s been important for residents like me to have the training where and when I need it. Otherwise, in the hospital there are few opportunities to apply the skills we are learning with patients. The repetition with NeoNatalie has been key,” says Labilloy.

Importance of Simulation
While many babies only need basic resuscitation, including stimulation, warmth, and suction, a small proportion – about 5 to 10 percent – need bag-mask ventilation (BMV) to establish their own respirations. The interim project results from 28 residents are promising. In a sub-group that rotated at a Cincinnati delivery hospital neonatal intensive care unit (NICU) where the low-dose/high-frequency practice with NeoNatalie provided weekly “just in place” simulation practice, the residents were faster at BMV than a sub-group of residents that rotated without the weekly simulation experience when assessed with a practical Objective Structured Clinical Evaluation (OSCE).

“At Cincinnati Children’s, we use innovative approaches to carry out intensive teaching of 180 residents over three years during their neonatology rotations so they can retain these basic resuscitation skills and have very good clinical outcomes,” says Javier Gonzalez del Rey, MD, MEd., director of the Pediatric Residency Program at Cincinnati Children’s.

The project team is also interested in the optimal intervals of simulation practice that are needed by the residents to maintain those skills once they leave their NICU rotation and complete pediatric residency training. This small-scale study supports the need for a larger research study. With additional funding, there is an opportunity to enhance the skills of more residents, which in turn can lead to more effective resident education and better outcomes for newborn patients.

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Beena Kamath-Rayne, MD, MPH was a recipient of the 2014 Association of American Medical Colleges Clinical Care Innovation Challenge Award. If you are interested in obtaining more information about this project or another CCIC project, please email innovationchallenge@aamc.org.

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