Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents

• Published in: The western journal of emergency medicine Vol. 21; no. 1; pp. 102 - 107
• Main Authors: Nickerson, Jillian Elizabeth, Webb, Taryn, Boehm, Lorraine, Neher, Hayley, Wong, Lillian, LaMonica, Julia, Bentley, Suzanne
• Format: Journal Article
• Language: English
• Published: United States University of California Digital Library - eScholarship 09-12-2019; Department of Emergency Medicine, University of California, Irvine School of Medicine; eScholarship Publishing, University of California
• Subjects: Adult; Cardiopulmonary resuscitation; Clinical Competence - standards; CPR; Educational Advances; Emergency medical care; Emergency Medicine - education; Feedback; Female; Health Knowledge, Attitudes, Practice; Humans; Infant, Newborn; Internship and Residency; Newborn babies; Obstetric Labor Complications - therapy; Perinatal Care; Pregnancy; Resuscitation - education; Shoulder Dystocia - therapy; Simulation; Simulation Training - methods
• ISSN: 1936-900X; 1936-9018; 1936-9018
• DOI: 10.5811/westjem.2019.10.43913

Newborn delivery and resuscitation are rare, but essential, emergency medicine (EM) skills. We evaluated the effect of simulation on EM residents' knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.
We developed a novel simulation that integrates a shoulder dystocia with neonatal resuscitation and studied a convenience sample of EM residents. Each 15-minute simulation was run with one learner, a simulated nurse, and a standardized patient in situ in the emergency department. The learner was required to reduce a shoulder dystocia and then perform neonatal resuscitation. We debriefed with plus/delta format, standardized teaching points, and individualized feedback. We assessed knowledge with a nine-question multiple choice test, confidence with five-point Likert scales, and clinical performance using a checklist of critical actions. Residents repeated all measures one year after the simulation.
A total of 23 residents completed all measures. At one-year post-intervention, residents scored 15% higher on the knowledge test. All residents increased confidence in managing shoulder dystocia on a five-point Likert scale (1.4 vs 2.8) and 80% increased confidence in performing neonatal resuscitation (1.8 vs 3.0). Mean scores on the checklist of critical actions improved by 19% for shoulder dystocia and by 27% for neonatal resuscitation.
Implementing simulation may improve EM residents' knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.