Cordero Leandro, Hart Brandon J, Hardin Rene, Mahan John D, Giannone Peter J, Nankervis Craig A
J Grad Med Educ. 2013 Sep;5(3):399-404. doi: 10.4300/JGME-D-12-00192.1.
Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill.
To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training.
Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership.
Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted.
Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.
儿科住院医师应具备新生儿复苏的准备能力，但研究表明住院医师在执行这项技能方面存在差距。
使用高仿真模拟人评估儿科住院医师在新生儿复苏（NR）过程中的操作技能和团队表现，并评估住院医师在培训前后对其NR技能的信心。
两组住院医师（均已完成NR项目培训）在新生儿重症监护轮转期间，于场外产房参加了两场单独的、时长90分钟的课程（相隔2至3周）。在每场课程前调查住院医师协助和主导NR的信心。各团队参与了一个情景模拟（改编自NR项目），该情景模拟需要5项技能（正压通气、胸外按压、气管插管、脐静脉插管和肾上腺素给药）。使用视频记录进行总结汇报和评分。对技能的技术和及时性进行评分，对团队行为的沟通、管理和领导能力进行评分。
26名住院医师（11个团队）完成了2次配对课程。两次课程之间自我信心得分有所提高，但与表现无关。观察到操作技能表现存在差距，大多数技能的及时性未达预期。注意到团队沟通有显著改善。
通过NR模拟培训发现操作技能表现存在重要差距，尤其是及时性；住院医师自信心的提高并未反映实际表现的提升。他们在NR方面相对缺乏准备（尽管之前已获得认证），这凸显了在新生儿重症监护产房轮转之前和期间进行刻意练习和特定团队培训的必要性。
