Cross-sectional study in Madagascar demonstrates efficacy of virtual mentoring and flipped classroom modifications of neonatal resuscitation programme Helping Babies Breathe.

AIM: The Covid-19 pandemic necessitated virtual adaptation of the neonatal resuscitation programme Helping Babies Breathe (HBB). This study assessed one such virtually mentored and flipped classroom modification in Madagascar. METHODS: A cross-sectional study was performed in September 2021 and May 2022. Healthcare providers were identified by local collaborating organisations. United States-based master trainers collaborated with local trainers on virtually mentored trainings followed by independent trainings. Master trainers were available for consultation via Zoom during the virtual training. A flipped classroom modification and traditional didactic method were compared. Primary outcomes were knowledge and skill acquisition, evaluated by written assessments and objective structured clinical examinations. RESULTS: Overall, 97 providers completed the curriculum. Written assessment scores improved in both training models (traditional-74.8% vs 91.5%, p < 0.001; flipped classroom-89.7% vs 93.6%, p < 0.05). There was no significant difference among written assessment scores (92.8% vs 91.5%, p = 0.62) and significantly higher objective structured clinical examination scores (97.3% vs 89.5%, p < 0.001) for the independent training compared to the virtually mentored training. CONCLUSION: The virtually mentored HBB training was followed by a successful independent training as measured by participant knowledge and skill acquisition, supporting the efficacy of virtual dissemination.

Skill retention after traditional versus video resuscitation training in filipino nursing students

INTRODUCTION: The Philippines has a high neonatal mortality rate. Helping Babies Breathe (HBB) simulation training has been shown to reduce early neonatal mortality with a focus on initiating bag mask ventilation (BMV) within the first minute of life. The frequency and interval for refresher training to ensure competence in HBB skills is not well-described. This study was conducted to assess the retention of resuscitation skills by Filipino nursing students when refresher HBB coursework is delivered via traditional in-person instruction compared to coursework delivered via remote telecoaching (video), with time to initiate BMV as the primary outcome. METHODS: Nursing students in Mati, Philippines (n=49) were traditionally trained in HBB;validated OSCE was used to assess pre-training and post-training skills. Students were divided into 2 month, 4 month, and 6 month follow-up and further divided within these time-based groups into video (V) or traditional (T) follow-up, for a total of 6 novel groups. OSCE was administered to test skill retention at follow-up. RESULTS: No student successfully performed BMV prior to 1 minute during pre-testing;immediately post-training, 73% of students performed BMV prior to 1 minute with an average time of 57.9 seconds. Students retested at 2 months averaged of 83.7 s and students retested for the first time at 4 months averaged 90.2 s prior to BMV initiation. Students tested for a second time at 4 months, following their initial retraining at 2 months, initiated BMV at an average of 70.4 s. There was no significant difference in individual decay of time to initiation of BVM between video and traditional trainees at 4 month follow-up (p=0.77). Due to COVID-19 restrictions, 6 month follow-up was unable to be completed. CONCLUSIONS: Skill decay was evident in both groups, with time to initiate BMV increasing between assessments. However, with a single refresher training, decay declined;it is likely this trend would continue with more frequent training. The finding of no significant difference between time to BMV after video vs traditional re-training suggests that virtual training may be a reasonable alternative in the future. This may be particularly important in the current era of educational modifications necessitated by pandemic travel restrictions.

Implementation and evaluation of a simulation-based shock curriculum in the Philippines

INTRODUCTION: Children in low-middle income countries are disproportionately affected by shock, resulting in high mortality. Simulation has been successfully used as an educational tool in some low-resource settings. The objective of this study was to develop and evaluate educational efficacy of a simulation-based pediatric shock curriculum for pediatric residents in Manila, Philippines. We hypothesized that there would be decreased time to administration of first fluid bolus on a simulated mannequin after participation in the curriculum. METHODS: Prospective pre/post cohort study assessing a skills-based shock curriculum consisting of a multiple choice pre/post-test and a videotaped simulation-based pre/posttest. Implemented at Philippine Children's Medical Center in March 2020. Performance in simulation shock scenario was assessed by standardized checklist. Outcome measures were compared pre- and post intervention. Interrater and intrarater reliability on checklist assessed. RESULTS: Due to the COVID-19 pandemic, resident enrollment in the study was stopped prematurely. A total of 24 residents were enrolled. 96% of participants were female. Individuals reported a mean of 4/5 confidence in English in the medical setting (SD .66 CI 95% 3.7-4.3). Confidence in identifying shock (3.8 -> 4.3 p <0.01), identifying malnutrition (3.2 -> 4.1 p <0.01), managing hypovolemic shock (3.6 -> 4.3 p <0.01), managing septic shock (3.3 -> 4.1 p <0.01) and placing an IO (2.8 -> 4.0 p <0.01) all increased. Mean written test score showed no significant improvement (9.4/10 to 9.8/10, p = 0.15) but this may have been related to high pre-intervention performance on knowledge based test. The time to initiation of fluids did not change (83 s -> 75 s p = 0.42), although all residents initiated fluids within five minutes both pre and post-intervention. The total score on the checklist improved (9.8 -> 14.7, p <0.01). CONCLUSIONS: There was no difference in time to initiation of fluids pre/post intervention. There was improvement in confidence with shock concepts. Overall score on the checklist improved, which may be the most accurate marker of knowledge acquisition in this scenario. Through international collaboration it is possible to establish a successful simulation-based education program for trainee.