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Updated: Jun 30, 2026
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Published on: May 6, 2020
Web-based versus simulation-based refresher training in newborn life support: A randomized multicenter noninferiority
Kathleen Parthey1, Anne Goldhahn1, Anselm Linke2
1Department of Pediatrics II, University Hospital, Martin Luther University Halle-Wittenberg, Halle, Germany.
Background:
Regular training for healthcare professionals in newborn life support is life-saving. Web-based refresher has the potential to be non-inferior to simulation-based refresher training.
Methods:
The multicenter non-inferiority randomized controlled trial was conducted in six hospitals Level I-IV in Germany. Following an initial full-scale, high-fidelity simulation training, we compared a web-based refresher with a simulation-based refresher. The professionals were assessed at three points in time, using a pseudonymised questionnaire and a Megacode test, scores added up to a sum score. Assessment was performed prior to, and immediately after the initial training and three months after the intervention. The primary aim was to analyze whether a web-based refresher is non-inferior in avoiding skill decay. Participation at the refresher and recurring errors were secondary outcomes.
Results:
Of 228 randomized healthcare professionals, 139 (web-based refresher group n = 78 vs. simulation-based refresher group n = 61) completed the study per protocol. The mean sum scores ± SD 3 months after the refresher was 47.0 ± 5.6 in the simulation-based group and 45.2 ± 6.5 in the web-based group (mean difference -1.7 ± 1.05 standard error), with similar results in the sensitivity test per modified intention-to-treat (Fig. 2). The lower limit of the one-sided 95% confidence interval (CI) did not exceed the predefined non-inferiority limit of δ = 5 points in both analyses (per protocol: one-sided 95% CI = -3.45; modified intention to treat: one-sided 95% CI = -1.95; Fig. 3). The participation in the web-based group was 14% higher. Incorrect adrenaline application and incorrect ventilation fraction, for example, were identified as recurring errors.
Conclusion:
Although underpowered to make a firm inference, our results suggest that web-based refresher is non-inferior compared to simulation-based refresher training, even in practical skills and shows a higher participation rate.
