Neonatal resuscitation: are your trainees performing as you think they are? A retrospective review of a structured resuscitation assessment for neonatal medical trainees over an 8-year period

Abstract

Objective: To ascertain whether Newborn Life Support Course (NLS) accredited trainees could demonstrate resuscitation skills appropriate to their level of training by providing standardised assessments of both junior and senior paediatric trainees during their induction period.

Design: Retrospective review of medical staff resuscitation assessments over an 8-year period from 2003 to 2010.

Setting: A network-lead tertiary neonatal service with over 11 000 deliveries annually.

Participants: Neonatal medical staff: junior (speciality trainee(ST) of years 1-3) and senior trainees (ST 4-8 with tier 2 on-call responsibilities).

Intervention: A standardised criterion-referenced assessment was performed by two NLS instructors. Junior trainee assessment focused on the basic airway skills learnt on an NLS course. Senior trainees demonstrated resuscitation of a baby with meconium-stained liquor, focusing on advanced life support, including intubation of the mannequin.

Main outcome measures: Assessment outcomes were pass/fail; fails were categorised as algorithm failure, technical skills failure or both. For trainees who failed the first assessment, the outcome of the second assessment following appropriate feedback was recorded.

Results: Two hundred and sixty-two assessments were performed: 160 junior and 102 senior trainees; 98/160 (61%) of junior and 57/102 (56%) of senior trainees passed their first assessment; 69% of junior trainees who failed the first assessment had a second assessment recorded. There was a 79% pass rate at second assessment; 89% of senior trainees who failed a first assessment had a second assessment recorded. There was an 85% pass rate at second assessment. The majority of trainees who failed an assessment had problems with both the resuscitation algorithm and technical skills.

Conclusions: Significant numbers of trainees who have been formally trained in neonatal resuscitation skills previously do not pass the standardised resuscitation assessment, thus require an additional input to maintain their competence in neonatal resuscitation.