PERSPECTIVES ON NEONATAL RESUSCITATION TRAINING IN A CANADIAN PEDIATRIC RESIDENCY PROGRAM: COMMUNITY VERSUS TERTIARY CARE EXPERIENCES
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AbstractBACKGROUNDThe competencies involved in neonatal resuscitation include a thorough knowledge of transitional neonatal physiology as well as technical expertise, the ability to lead a multidisciplinary team, and appropriate management of resources. In Canadian paediatric training programs, residents acquire neonatal resuscitation competency in both community and tertiary care settings. There is limited literature regarding experiences of training in variable settings and no literature with respect to the integration of neonatal competency acquisition across training environments.OBJECTIVESTo explore residents’ and recent paediatric graduates’ perspectives on acquisition of competencies and neonatal resuscitation training in community and tertiary care centers.DESIGN/METHODSThis project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained.RESULTSOverall, the participants described a large ‘disconnect’ (lack of communication and congruence of curriculum) between community and tertiary training environments for neonatal resuscitation. Inherent challenges in the community included the variable skill and experience of the interdisciplinary team, availability of resources, and a lack of confidence in their own leadership. In addition, gaps in preceptor knowledge and communication were identified. Strengths of the community setting included: more autonomy for the learner, a high volume of clinical cases with particular emphasis on the ‘normal’; and opportunity for observed feedback with preceptors. In comparison, tertiary center experiences were perceived to be ‘overwhelming’ with a demanding workload and limited opportunity for direct observation and feedback from faculty. Strengths of the tertiary center experience included: variety and high volume of acute clinical cases, facilitating technical skill expertise and self-confidence; and a strong academic focus on physiology and knowledge translation.CONCLUSIONParticipants described both valuable opportunities and challenges for training and competency acquisition in neonatal resuscitation in tertiary and community settings. Integration of curricula or competencies across settings and across residency level of experience was lacking. This work suggests areas for collaboration within and across training centres to align opportunities in neonatal resuscitation competency training.
