# Simulation-Based Curriculum in the Neonatal Intensive Care Unit (NICU): The New Era of Medical Education

## TL;DR

This study shows that simulation-based training improves confidence and skills in neonatal care among medical fellows.

## Contribution

The study introduces a structured simulation curriculum to enhance neonatal-perinatal medicine fellows' clinical confidence and skills.

## Key findings

- Simulation-based training improved symptom recognition and scenario management skills significantly.
- Participants showed enhanced NRP resuscitation skills and code leadership abilities.
- Communication skills also improved notably after the simulation sessions.

## Abstract

Introduction

Simulations have been a cornerstone in teaching procedures and resuscitation algorithms in neonatal intensive care units (NICU). As advances in care and technology have reduced healthcare-related complications, simulations are being utilized to effectively increase confidence, link knowledge with clinical practice, and enhance procedural skills. The use of simulations in NICU training is on the rise, yet the quality and structure of neonatal simulations vary.

Objective

The objective is to enhance the self-efficacy and confidence of neonatal-perinatal medicine (NPM) fellows in managing common neonatal diseases in our NICU through simulation-based education.

Methods

A prospective educational cohort study was conducted in the NICU with NPM fellows. Fellows completed pre- and post-simulation questionnaires using a Likert scale. Each fellow completed six validated simulations based on NICU scenarios, with both pre-brief and debrief sessions. Statistical analyses were performed using SAS 9.4, with statistical significance defined as p<0.05. The difference between the pre- and post-intervention Likert scores was tested using the Wilcoxen rank-signed test.

Results

The study highlights positive shifts in five participants' confidence across diverse neonatal scenarios following their involvement in six simulations. Noticeable improvements are evident in symptom recognition (p<0.0001), scenario management (p<0.0001), NRP resuscitation skill (p=0.0029), code leadership (p=0.0004), and communication skills (p<0.0001). While p-values underscore statistical significance overall, adjusting for individual scenarios did not achieve statistical significance, due to the constraint of a smaller sample size.

Conclusion

Our study showed an overall positive impact on symptom recognition, scenario management, NRP resuscitation skills, code leadership, and communication skills, supporting the broader implementation of simulation-based training (SBT) in neonatology.