Friday, April 20, 2018

Improving procedural skills, teamwork and confidence in just one day: A NICU fellow bootcamp

Sadie Williams
Cincinnati Children's Hospital

Background: With increasing work hour restrictions and decreased clinical requirements in the neonatal intensive care unit (NICU), during pediatric residency, trainees may begin fellowship with decreased experience with critical procedural and communication skills.

Objective: The goal of this study was to develop a compact, simulation-based session focused on critical neonatal diagnoses and teamwork. We later evaluated evaluate whether this session was able to improve confidence and teamwork amongst new trainees.

Methods: Two cohorts of five fellows participated in the one-day bootcamp. Confidence in team leading and common neonatal procedures was assessed using a pre and post survey administered on the day of bootcamp as well as a delayed post-test 6 months following bootcamp. Teamwork and communication was assessed using the TEAM scale, with analysis of video recordings of the scenarios at the beginning and end of bootcamp.

Results: In comparing the same day pre-test and post-test, we found that fellows self-reported confidence was significantly improved in 5 out of 6 categories (Team leader in code situation (p < 0.001), team leader in the delivery room (p < 0.001), decision making (p < 0.001), endotracheal tubeintubation (p < 0.001), chest tube placement (p< 0.001) and umbilical catheter placement (p = 0.09). There was an overall improvement in teamwork, team leadership and communication throughout the day as measured by the TEAM scale (p < 0.001). There was no significant change in self-reported confidence scores in all categories 6 months following bootcamp.

Conclusions: We demonstrated a significant improvement in self-perceived confidence in regards to neonatal procedures, teamwork, and team leadership in first year neonatal-perinatal medicine fellows following a one-day high fidelity simulation-based bootcamp. The format for this bootcamp is workable and could be emulated in institutions across the country as a first step to improve the confidence and skill set of incoming fellows.