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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.
Introduction:
Newborns in rural hospitals face an increased risk of morbidity and mortality compared to those born in hospitals with a Neonatal Intensive Care Unit (NICU). Although causes are multifactorial, low delivery volume leads to infrequent neonatal resuscitation exposure. Simulation enables deliberate practice to maintain skills, but rural hospitals face barriers to accessing this training. The objectives of this study were to assess rural clinicians' ability to assess and recognize changes of state in a mixed reality (MR) simulator, HoloBaby, developed for neonatal resuscitation training, and to compare their experience to mannequin-based simulation, and their real neonatal resuscitation experience, using a mixed methods study design.
Methods:
Forty-five interprofessional clinicians from 3 rural hospitals participated in identical neonatal resuscitation simulations using first a programmable "high-technology" mannequin (HTM) and then HoloBaby. Surveys were conducted after each simulation experience and facilitated focus groups at the end of each study session to gauge clinicians' experience with the simulation technologies and their ability to effectively assess and recognize changes in patients. Logistic mixed effects regression models assessed the association between survey question components and training method. Thematic analysis was used to identify codes and themes from the focus group transcripts.
Results:
Participants reported that they were better able to effectively recognize shock in HoloBaby over the HTM. No other significant differences were noted between the technologies. Thematic analysis identified 3 main themes: novelty of MR technology, advantages and disadvantages of HoloBaby compared to the HTM, and value of simulation training (regardless of technology).
Conclusion:
The MR simulator, HoloBaby, offers the experience of simulation-based team training and matches the HTM in user ability to assess and recognize all changes in state measured, and exceeding HTM in users' ability to recognize shock. In addition, MR could reduce financial and geographic barriers to accessing regular simulation training in rural settings.
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