Efficacy of the neonatal resuscitation program (NRP) course on knowledge retained by residents: Comparison among pediatrics, anesthesia and gynecology

Neonatal resuscitation is a mandatory role for all the delivery room professionals, including midwives, nurses and physicians from different specialties (pediatrics, anesthesiology and gynecology). [1] and [2] However, the background training of the various health care providers presents important differences, which may require different strategies for the teaching of neonatal resuscitation fundamentals.3 The Neonatal Resuscitation Program (NRP), a widely adopted training program endorsed by the American Heart Association (AHA) and the American Academy of Pediatrics (AAP),2 has shown to provide good retention of knowledge in the participants, [4] and [5] but information regarding its efficacy in relation to the specialty training of the attendants is lacking. We evaluated the effectiveness of the NRP course in the knowledge gained by third year pediatrics, anesthesiology and gynecology residents in our centre. A total of 124 residents attended the course, held in our Hospital by certified NRP instructors, in the period between 2006 and 2009: 65 of them were training in pediatrics, 32 in anesthesia, 27 in gynecology. A 71-item questionnaire derived from the standard test contained in the AHA/AAP Neonatal Resuscitation Manual was administered to participants before and after the course. The percentages of correct answers significantly improved from before (61.07 ± 10.23%) to after the course (86.24 ± 5.60%; p < 0.001). The improvement was statistically significant in all the three groups (p < 0.001). The percentage of improvement in the post-test vs. pre-test was higher in gynecology (33 ± 8%) than anesthesiology (24 ± 8%) and pediatrics (22 ± 7%) residents (p < 0.001). However, both in the pre-test and in the post-test, pediatrics and anesthesiology residents obtained higher scores than gynecology residents (p < 0.001) (Fig. 1). The specific steps where gynecology trainees’ performance was lower than their colleagues in the post-test were about bag-mask ventilation, medications and special considerations. Full-size image Fig. 1. Percentage of correct answers before the course (pre-test) and immediately after the course (post-test). Data are expressed as mean ± SD. ***p < 0.001 vs. gynecology residents. View high quality image (207K) The results of this study show that residents improved their knowledge after the NRP course, regardless of the specialty they were training in. However, gynecology residents had lower pre-course performances, and despite the significant increase in the post-test score, they did not reach the same level as their colleagues in pediatrics and anesthesia. In our institution, pediatrics and anesthesiology residents, as part of the rotations of the first two years of their programs, follow staff neonatologists and anesthesiologists in Neonatal Intensive Care Unit activity. Therefore, unlike their gynecology colleagues, they are routinely exposed to procedures such as positive pressure ventilation and administration of drugs. These differences may explain, at least in part, the better performances observed in the first two groups in our study. Our findings highlight the fact that learning of the theoretical principles of neonatal resuscitation by health care professionals is influenced by their background training/previous experience. These aspects are of interest to instructors and residency program directors in order to optimize the training of physicians in this field. Further investigations are needed to evaluate additional tools that could support this program in order to reach optimal knowledge, especially for those physicians that are less frequently involved in the clinical practice of neonatal resuscitation.