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Simul Healthc. 2019 Feb 25. doi: 10.1097/SIH.0000000000000353. [Epub ahead of print]

A Simulation-Based Pilot Study of a Mobile Application (NRP Prompt) as a Cognitive Aid for Neonatal Resuscitation Training.

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From the Allan Waters Family Simulation Centre, Li Ka Shing Knowledge Institute (D.M.C.), St. Michael's Hospital; Division of Neonatology, Department of Pediatrics, University of Toronto (N.H.C., D.M.C.); Department of Pediatrics, St. Michael's Hospital (N.M., D.M.C.); and Division of Paediatric Medicine (N.M.), The Hospital for Sick Children, Toronto, ON, Canada.



Despite standardized neonatal resuscitation program (NRP) training, retention and adherence to the NRP algorithm remain a challenge. Cognitive aids can potentially improve acquisition and application of NRP knowledge and skills. The objective of this study was to determine whether an interactive mobile application providing audiovisual prompts, NRP Prompt, can help novice NRP providers learn the NRP algorithm more effectively and therefore improve their NRP performance.


First- and second-year residents from family medicine and obstetrics and gynecology attending NRP training were randomized into intervention and control groups. Resident pairs used standard visual aids with NRP Prompt (intervention) or visual aids only (control) in two simulated neonatal resuscitation training sessions with each resident taking turns as a team leader. Pairs were then evaluated in a third simulation that was video recorded, where neither group used cognitive aids. The primary outcome was comparing resuscitation performance. Secondary outcomes included the following: times to positive-pressure ventilation, intubation, and chest compressions.


Thirty-nine residents participated, of which 18 received the intervention. Neonatal resuscitation program performance scores did not significantly differ (P = 0.69). Wilcoxon rank-sum tests showed no significant differences in secondary outcomes of times to positive-pressure ventilation (P = 0.43), intubation (P = 0.44), or chest compressions (P = 0.35).


Training using NRP Prompt did not improve performance scores in simulated neonatal resuscitations immediately after training. Potential reasons include voice prompts in their current format being distracting and lack of customizability to user preferences. Future development of prompting applications should apply a user-centered design approach to optimize the ability to meet end-user needs.

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