Abstract
Resuscitation Training for healthcare professionals (RETAIN) is an immersive simulation-based platform that aims to improve access for neonatal resuscitation providers. This review of the research that measures the educational outcomes of training with RETAIN identified nine original research papers, two review papers, and one case study. Findings show that RETAIN is clinically relevant, engaging, improves short-and long-term knowledge and transfer of the key steps of neonatal resuscitation, and may be used as a formative or summative assessment. Further, performance on the RETAIN digital simulator was moderated by healthcare professional (HCP) attitudes, including growth mindset, and was compared across clusters obtained based on HCPs' attitudes towards technology. This simulator presents an attractive and accessible immersive learning approach towards training and assessing neonatal resuscitation competence. By improving the knowledge and skills of neonatal resuscitation providers, immersive media such as RETAIN may ultimately improve health outcomes for our smallest patients.
TopIntroduction
You are working the night shift in the neonatal intensive care unit and have just been called to the labor and delivery ward, as a baby is about to be born. You enter the room right in time to see the mother deliver her first child—a baby boy. Surrounding her at the bedside are the baby’s father, grandparents, aunts, and uncles—who for the past nine months have expectantly waited for the day they would finally meet their newest family member. You look over to the obstetrician, who encourages the mom to give one final push. Everyone in the room anxiously holds their breath, anticipating the baby’s first cry... But the room remains silent. All at once, the delivery room breaks out in a flood of sound and activity. The doctor clamps the umbilical cord, and a team of healthcare professionals (HCPs) quickly rush the baby away from his family and into the adjacent room. The family is left with nothing to do but wait, while the healthcare team tries to get their newborn baby to take his first breaths.
Each year, approximately 10% of newborn babies will need help to breathe at birth (Wyckoff et al., 2015). Sadly, one million of these babies will never make it back to their family’s expectant arms (Lawn et al., 2007). Helping babies breathe is the cornerstone of neonatal resuscitation (American Heart Association, 2016). During neonatal resuscitation, HCPs must work together to provide complex and coordinated care under intense pressures of time and stress. HCPs must synthesize information simultaneously from the baby’s case history, visual appearance, and cardiorespiratory status to appropriately provide care (e.g., ventilation, intubation, chest compressions, and intravenous medication; American Heart Association, 2016). Neonatal resuscitation is a cognitively and physically demanding medical emergency, and therefore errors by HCPs are common (Joint Commission, 2004; LeBlanc et al., 2005). The delivery room is one of the highest risk areas in a hospital where errors can have devastating consequences for infant morbidity and mortality (Joint Commission, 2004; Lipman et al., 2011).
To address this gap, the International Liaison Committee on Resuscitation has developed the Neonatal Resuscitation Program (NRP), a standardized training course and education program to teach neonatal resuscitation providers the guidelines of evidence-based care (American Heart Association, 2016). The NRP is rooted in simulation-based education, prioritizing immersive and interactive learning experiences over a pedagogical approach (American Heart Association, 2016; Lipman et al., 2011).
Neonatal Resuscitation Program (NRP)
The NRP consists of two parts. First, an at-home portion enables learners to read the neonatal resuscitation textbook and complete an online multiple-choice exam. Second, an in-class portion offers learners an opportunity to attend hands-on individual-skills stations and group simulation scenarios (American Heart Association, 2016). The NRP course has set a global standard for immersive learning through simulation in critical care medicine. However, neonatal resuscitation providers are only required to complete the course once every two years (American Heart Association, 2016), which may be insufficient to maintain long-term competence (Matterson et al., 2018). While more frequent simulation sessions are needed, traditional simulation can be resource-consuming, requiring a manikin, access to a simulation lab, and supervision by a trained instructor (Binotti et al., 2019; Mileder et al., 2014). Moreover, as neonatal resuscitation is a high-acuity, low-occurrence (HALO) event, HCPs have limited opportunities to learn by attending actual clinical cases (Cutumisu et al., 2019).
Barriers towards frequent immersive learning experiences prohibit neonatal resuscitation providers from adequately maintaining their knowledge and skills, leaving them dangerously underprepared to act quickly and correctly during a clinical emergency (Joint Commission, 2004). An alternative approach to simulation training is needed—one that is effective, engaging, and efficient (Ghoman et al., 2020). Immersive media like tabletop, digital, and virtual reality simulators offer promising solutions to augment traditional neonatal resuscitation education and teach relevant knowledge or skills within an engaging learning environment (Ghoman et al., 2020; Bellotti et al., 2010).
Key Terms in this Chapter
Infant: A human being within the first year after birth.
Newborn: A human being within the first 28 days after birth.
Simulation: Training, practice, and learning technique that aims to replicate essential aspects of real experiences or situations.
Neonatal Resuscitation Program (NRP): A program designed to help build neonatal resuscitation knowledge, skills, and confidence to prepare trainees to resuscitate a newborn infant (neonate).
Game-Based Learning: Subcategory of serious games with the main purpose of learning and education, rather than just of entertainment.
Healthcare Professional (HCP): An individual who may provide health care treatment and advice based on formal training and experience.
Retain: Resuscitation Training for healthcare professionals constitutes a collection of computer games, video games, and tabletop games for neonatal resuscitation.
Neonatal Resuscitation: The set of interventions at the time of birth to re-establish and support infants’ breathing and circulation.