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Neonatal resuscitation instructors

Question Type:
Intervention
Full Question:
In neonatal resuscitation instructors (P), does formal training on specific aspects of how to facilitate learning  (I), compared with generic or nonspecific training  (C), change clinical outcome, improve all levels of education or practice (O)?
Consensus on Science:
For the critical outcome of improvement in patient outcome, we identified no evidence. For the critical outcome of improvement in learner performance in the real clinical environment, we identified very-low-quality evidence from 1 randomized clinical trial (Naji 1986, 140) (downgraded for indirectness, risk of bias, and imprecision) that providing structured self-reflection and peer group feedback to psychiatry registrars improved their students’ performance of standardized psychiatric interviews. For the critical outcome of improvement in learner performance in educational settings, we identified very-low-quality evidence (downgraded for indirectness, imprecision, and risk of bias) from 1 randomized clinical trial (Breckwoldt 2014, 6) in which 18 emergency medicine instructors were randomly assigned to 2 intervention groups and trained 193 medical students. The study found that learners trained by instructors who underwent a 2-day teacher training course focused on education principles performed at an equal or lower level of proficiency in technical skills when compared with those trained by instructors who did not attend the 2-day course. For the critical outcome of improvement in all levels of education or practice, we identified low-quality evidence (downgraded for indirectness and bias) from 5 randomized clinical trial (Skeff 1986, 315; Schum 1996, 1100; Litzelman 1998, 324; Boerboom 2011, e615; Breckwoldt 2014, 6) enrolling 271 participants (not estimable). Several studies did note at least temporary deterioration in instructor performance after commencement of new instructor training intervention. For the critical outcome of improvement in clinical outcome, we identified no evidence. For the important outcome of improvement in instructor performance, we identified very-low-quality evidence (downgraded for indirectness and bias) from 5 randomized clinical trials (Skeff 1986, 315; Schum 1996, 1100; Litzelman 1998, 324; Boerboom 2011, e615; Breckwoldt 2014, 6) and 2 nonrandomized trials.(Lye 2003, 93; Regan-Smith 2007, 278) No meaningful numerical summary of the results of these studies could be performed. These studies indicate that preparation of instructors produces inconsistent results in terms of instructor performance. While it does seem that written and verbal feedback, delivered in a constructive and timely manner, often produces improvement in instructor performance, in other instances posttraining deterioration in aspects of instructor performance was seen, at least initially. We suggest that training of resuscitation instructors incorporate timely, objective, structured, individually targeted verbal and/or written feedback (weak recommendation, low-quality evidence).
Treatment Recommendation:
Values, Preferences, and Task Force Insights While common sense dictates that instructors be properly prepared before engaging learners, it is clear that such instruction must be based on specific learning objectives targeting the specific skills that are necessary to facilitate learning. Definitions of these skills will require collaboration with colleagues in fields such as human factors and ergonomics who have experience in examining human performance in high-risk domains (similar to the delivery room) rather than relying solely on those with expertise in traditional education settings such as the classroom. Deliberations of the Task Force and Writing Group The PICO question may be too global/broad. Perhaps we need to be more specific in the future. We may need to move away from dependence on traditional methodologies and look to those industries where adults are trained to be proficient in specific tasks. Instructors need to know how to do specific tasks and give feedback to improve performance. Perhaps we have made instructors poor trainers. People who develop curricula need to address this critical deficit. How do we teach task proficiency? That is what is most needed.
CoSTR Attachments:
NRP 867 Bias assessments non-RCTs.docx    
NRP 867 Bias assessments RCTs.docx    
NRP 867 Evidence profile table instructor performance.docx    
NRP 867 Evidence profile table learner performance.docx    

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