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A Mixed Methods Pilot Study of Neonatal Resuscitation Team Training for Rural Providers Using HoloBaby, a Mixed

Michael A Ferguson1, Micheline Chipman, Anya Cutler

  • 1From the Tufts School of Medicine (M.A.F.), Pediatric Intensive Care, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; The Hannaford Center for Safety, Innovation and Simulation (M.C.), Department of Medical Education, Maine Medical Center, Portland, ME; MaineHealth Institute for Research (A.C.), Center for Interdisciplinary Population and Health Research, Department of Pediatrics Scholars Academy, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Interactive Commons (M.A.G.), Case Western Reserve University, Cleveland, OH; Tufts University School of Medicine (L.M.), Boston, MA, The Hannaford Center for Safety, Innovation and Simulation, Department of Medical Education; Department of Pediatrics, Section of Hospital Medicine, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Tufts University School of Medicine (M.M.), Boston, MA, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Department of Pediatrics Scholars Academy (L.M.S.), The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Tufts University School of Medicine (A.Z.), Boston, MA, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Tufts School of Medicine (M.Z.), Pediatric Intensive Care, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Tufts University School of Medicine (M.O.), Boston, MA; MaineHealth Child Health Service Line; Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME.

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
|August 5, 2025
PubMed
Summary
This summary is machine-generated.

Rural clinicians using the HoloBaby mixed reality simulator improved their ability to recognize shock during neonatal resuscitation training. This technology offers a valuable alternative to traditional methods, overcoming barriers to simulation access in rural areas.

Keywords:
MRVirtual realityaugmented realityhealth care disparitymixed realityneonatal resuscitationrural health

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Area of Science:

  • Medical Simulation
  • Neonatal Resuscitation
  • Mixed Reality Technology

Background:

  • Rural newborns face higher morbidity and mortality risks due to limited access to Neonatal Intensive Care Units (NICUs).
  • Low delivery volumes in rural hospitals reduce clinicians' exposure to neonatal resuscitation, impacting skill maintenance.
  • Barriers to simulation training access hinder skill development for rural healthcare providers.

Purpose of the Study:

  • To evaluate rural clinicians' proficiency in assessing and recognizing patient state changes using the HoloBaby mixed reality (MR) simulator.
  • To compare clinician experiences with HoloBaby versus traditional mannequin-based simulation.
  • To assess the perceived value of MR simulation compared to real-world resuscitation experiences.

Main Methods:

  • A mixed-methods study involving 45 interprofessional clinicians from three rural hospitals.
  • Participants completed identical neonatal resuscitation simulations using a high-technology mannequin (HTM) and HoloBaby MR simulator.
  • Data collected via post-simulation surveys and facilitated focus groups; analyzed using logistic mixed effects regression and thematic analysis.

Main Results:

  • Clinicians reported superior recognition of shock using HoloBaby compared to the HTM.
  • No significant differences were found between HoloBaby and HTM in assessing/recognizing other patient state changes.
  • Thematic analysis revealed themes of MR technology novelty, comparative advantages/disadvantages of HoloBaby, and the overall value of simulation training.

Conclusions:

  • The HoloBaby MR simulator provides effective simulation-based team training, matching HTM performance and exceeding it in recognizing shock.
  • MR simulation, like HoloBaby, can mitigate financial and geographic barriers to regular neonatal resuscitation training in rural settings.
  • HoloBaby shows promise for enhancing neonatal resuscitation skills and improving outcomes for newborns in underserved areas.