Impact of a Prospective Simulation-Based Mastery Learning With Deliberate Practice Intervention on Neonatal Intubation.

Objective: To design and implement a simulation-based mastery learning (SBML) curriculum utilizing deliberate practice (DP) for neonatal intubation in the delivery room setting. We sought to investigate the impact this curriculum would have on performance and skill retention.

Methods: A prospective single-group SBML with DP intervention to improve intubation success was implemented from 2019 to 2022. Pediatric hospitalists (PHs) and neonatal nurse practitioners (NNPs) who provide care in the delivery room were eligible to participate. An 11-item checklist was developed, and a minimum passing standard (MPS) was set using the Mastery Angoff method. Participants underwent a baseline assessment, followed by DP with expert feedback. Post-intervention assessments were completed until the MPS was achieved, with additional practice rounds if needed. After three to six months, all participants underwent a retention assessment. If MPS was not achieved at retention, further DP was provided until MPS was met.

Results: At the time of enrollment, 95% of participants had limited experience with attempted neonatal intubation (less than five performed), and 14% had never attempted an actual neonatal intubation. At baseline assessment, 95% of participants did not meet the MPS. Participants' mean scores significantly improved on the intubation checklist from 74% to 99% from baseline to post-training assessment. The intervention was significant and impactful, with effect sizes of >2. At the three-to-six-month retention assessment, 66% of participants met the MPS on the first attempt. Overall, 92% reported an increased confidence level with the procedure and an improvement in their clinical practice.

Conclusions: Our SBML with DP neonatal intubation curriculum is an effective tool to train providers in neonatal intubation for the delivery room environment. As clinical opportunities to learn this procedure continue to decline, programs must develop ways to optimize proficiency in this skill.