P2.F101: Mental rehearsal as a cognitive tool for enhancement of non-technical skills in neonatal resuscitation

Background: Advanced neonatal resuscitation encompasses complex clinical scenarios that require technical proficiency and non-technical leadership skills. Mental rehearsal (MR) is a technique that enables individuals to think through the process of the skills they are about to perform prior to performing them. MR has previously been shown to improve the performance of technical skills in medical and surgical settings. It has not been studied with respect to optimization of the non-technical skills used in neonatal resuscitation. The primary objective of this study was to examine whether MR affects measures of non-technical skills performance during simulated neonatal resuscitation. Secondary objectives included assessment of competency in NRP technical skills.

Methods: This was a prospective, randomized, controlled simulation-based trial. Participants included NRP-trained healthcare practitioners (HCP) who were neonatal-perinatal medicine fellows and advanced practice providers and were randomized to either control or intervention groups stratified by experience level. All participants completed a baseline neonatal resuscitation simulation (sim1). The intervention group received a standardized MR script that provided guided visualization of the general steps of neonatal resuscitation. The control group received a packet of standardized NRP training materials. Both groups were instructed to study the materials for 20 minutes prior to a post-intervention simulation (sim2) that occurred at least 1 week after sim1. Sessions were video recorded for scoring by two independent reviewers masked to study group. Non-technical skills were evaluated using the Anesthetists’ Non-technical Skills (ANTS) tool, scored on a scale from 0 to 4. Technical skills were evaluated using the Neonatal Resuscitation Performance Evaluation (NRPE) tool. A sample size of 32 subjects was required to find a difference of 0.5 in ANTS score from sim1 to sim2 with 80% power and alpha of 0.05.

Results: 35 participants consented, and 31 were randomized to the control (n=15) and intervention groups (n=16), completing both simulations. The baseline demographics and experience levels were similar between groups (Table). The mean (SD) ANTS score increased from 2.77 (0.66) in sim1 to 3.12 (0.49) in sim2 (p < 0.001). The mean (SD) NRPE score increased from 80.5% (12.2%) in sim1 to 86.6% (7%) in sim2, p=0.009. There were no differences in ANTS and NRPE scores from sim1 to sim2 between randomization groups. The mean (SD) change in ANTS scores from sim1 to sim2 was 0.42 (0.49) for junior clinicians and 0.28 (0.57) for more senior clinicians, p=NS. The mean change in NRPE score was 7.6% (10.8%) for junior clinicians and 2.0% (8.8%) for more senior clinicians. The changes in scores from sim1 to sim2 for each subject are shown in the Figure.

Conclusion: Mental rehearsal did not improve ANTS or NRPE scores more than review of NRP materials. Non-technical and technical skills can be improved over time with repetition and dedicated review of materials.