Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

Journal of Perinatology volume 32, pages 287–292 (2012)Cite this article

Abstract

Objective:

Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees.

Study Design:

Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made.

Result:

The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P=0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups.

Conclusion:

Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Weinstock PH, Kappus LJ, Kleinman ME, Grenier B, Hickey P, Burns JP . Towards a new paradigm in hospital-based pediatric education: the development of an onsite simulator program. Pediatr Crit Care Med 2005; 6 (6): 635–641.

    Article  Google Scholar 

  2. Jewkes F, Phillips B . Resuscitation training of paediatricians. Arch Dis Child 2003; 88 (2): 118–121.

    Article  CAS  Google Scholar 

  3. Durojaiye L, O’Meara M . Improvement in resuscitation knowledge after a one-day paediatric life-support course. J Paediatr Child Health 2002; 38 (3): 241–245.

    Article  CAS  Google Scholar 

  4. Quan L, Shugerman RP, Kunkel NC, Brownlee CJ . Evaluation of resuscitation skills in new residents before and after pediatric advanced life support course. Pediatrics 2001; 108 (6): E110.

    Article  CAS  Google Scholar 

  5. Hayes CW, Rhee A, Detsky ME, LeBlanc VR, Wax RS . Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: a survey of internal medicine residents. Crit Care Med 2007; 35 (7): 1668–1672.

    Article  Google Scholar 

  6. Morgan R, Westmoreland C . Survey of junior hospital doctors’ attitudes to cardiopulmonary resuscitation. Postgrad Med J 2002; 78 (921): 413–415.

    Article  CAS  Google Scholar 

  7. Scott G, Mulgrew E, Smith T . Cardiopulmonary resuscitation; attitudes and perceptions of junior doctors. Hosp Med 2003; 64 (7): 425–428.

    Article  Google Scholar 

  8. Keinan G, Friedland N . Training effective performance under stress: queries, dilemmas, and possible solutions In: Driskell JE, Salas E (eds). Stress and Human Performance. Lawrence Erlbaum Associates: Mahwah, NJ, 1996.

    Google Scholar 

  9. Inzana CM, Driskell JE, Salas E, Johnston JH . Effects of preparatory information on enhancing performance under stress. J Appl Psychol 1996; 81 (4): 429–435.

    Article  CAS  Google Scholar 

  10. Seropian M, Brown K, Gavilanes J, Driggers B . Simulation: not just a manikin. J Nurs Educ 2004; 43 (4): 164–169.

    PubMed  Google Scholar 

  11. Gaba DM, DeAnda A . A comprehensive anaesthesia environment; recreating the operating room for research and training. Anaesthesiology 1988; 69 (3): 387–394.

    Article  CAS  Google Scholar 

  12. Chopra V, Engbers FH, Geerts MJ, Filet JG, Bovill JG, Spierdijk J . The Leiden anaesthesia simulator. Br J Anaesth 1994; 73 (3): 287–292.

    Article  CAS  Google Scholar 

  13. Van der Heide PA, van Toledo-Eppinga L, van der Heide M, der Lee JH . Assessment of neonatal resuscitation skills: a reliable and valid scoring system. Resuscitation 2006; 71 (2): 212–221.

    Article  Google Scholar 

  14. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R . Anaesthetists’ non-technical skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 2003; 90 (5): 580–588.

    Article  CAS  Google Scholar 

  15. Kurrek MM, Devitt JH . The cost for construction and operation of a simulation centre. Can J Anaesth 1997; 44 (11): 1191–1195.

    Article  CAS  Google Scholar 

  16. Bohnen N, Houx P, Nicolson N, Jolles J . Cortisol reactivity and cognitive performance in a continuous mental task paradigm. Biol Psychol 1990; 31 (2): 107–116.

    Article  CAS  Google Scholar 

  17. Wachtel PL . Anxiety, attention and coping with threat. J Abnorm Psychol 1968; 73 (2): 137–143.

    Article  CAS  Google Scholar 

  18. Buchanan TW, Tranel D . Stress and emotional memory retrieval: effects of sex and cortisol response. Neurobiol Learn Memory 2008; 89 (2): 134–141.

    Article  CAS  Google Scholar 

  19. Kuhlmann S, Piel M, Wolf OT . Impaired memory retrieval after psychosocial stress in healthy young men. J Neurosci 2005; 25 (11): 2977–2982.

    Article  CAS  Google Scholar 

  20. Salas E, Driskell JE, Hughes S . Introduction: the study of stress and human performance. In: Driskell JE, Salas E (eds). Stress and Human Performance. Lawrence Erlbaum Associates: Mahwah, NJ, 1996.

    Google Scholar 

  21. Vedhara K, Hyde J, Gilchrist ID, Tytherleigh M, Plummer S . Acute stress, memory, attention and cortisol. Psychoneuroendocrinology 2000; 25 (6): 535–549.

    Article  CAS  Google Scholar 

  22. Johnston JH, Cannon-Bowers JA . Training for stress exposure In: Driskell JE, Salas E (eds). Stress and Human Performance. Lawrence Erlbaum Associates: Mahwah, NJ, 1996.

    Google Scholar 

  23. Gaab J, Blattler N, Menzu T, Pabst B, Stoyer S, Ehlert U . Randomized controlled evaluation of the effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology 2003; 28 (6): 767–779.

    Article  CAS  Google Scholar 

  24. Idzikowski C, Baddeley AD . Fear and dangerous environments. In: Hockey R (ed). Stress and Fatigue in Human Performance. Wiley: Chicester, 1983 pp, 123–144.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, University of Toronto, Toronto, ON, Canada

    E Finan, H E Whyte & P J McNamara

  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Z Bismilla

  3. Wilson Centre for Research in Education, Toronto, ON, Canada

    V LeBlanc

Authors
  1. E Finan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z Bismilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H E Whyte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V LeBlanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P J McNamara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P J McNamara.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Finan, E., Bismilla, Z., Whyte, H. et al. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training. J Perinatol 32, 287–292 (2012). https://doi.org/10.1038/jp.2011.96

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2011.96

Keywords

This article is cited by

Search

Advanced search

Quick links