Context This quality improvement project was conducted in a local neonatal unit in a district general hospital. It involved junior doctors in training, specifically Foundation Year 2 (FY2) and Specialist Trainee 1 (ST1) doctors. This group was identified as potentially inexperienced at working within a neonatal unit. Data from the first cohort of FY2-ST1s demonstrated concerns about confidence and determined the need for an intervention, which was then implemented for the new (termed ‘second’) cohort.

Problem There was a pre-existing neonatal induction programme including basic NLS (Neonatal Life Support) training and senior pairing for attending deliveries for the first two weeks for new trainees. However, the FY2-ST1s felt overwhelmed and underprepared for their neonatal role, particularly regarding attending deliveries. This was leading to a lack of confidence in their abilities.

Assessment of problem and analysis of its causes A retrospective questionnaire was sent to the initial cohort of FY2-ST1s, inviting comment on prior expectations of their neonatal job role and previous experience, and asked how prepared they felt by different elements of induction to attend deliveries competently. Data collected suggested that although they felt NLS training within induction was moderately useful, with no previous experience or knowledge it seemed overwhelming. They suggested that more information prior to starting would have been useful, and therefore the concept of developing some pre-induction materials was born.

Intervention Three short pre-induction videos were designed and produced by the authors, to be sent to all new starters, entitled “Setting up the Resuscitaire”, “Attending a Delivery” and “Troubleshooting the Resuscitaire”. These were designed to familiarise new starters with the equipment and demonstrate a neonatal resuscitation scenario. Videos could then be used for reference after starting the job.

A second intervention of simulation sessions aimed at FY2-ST1s were also implemented in the first 2 weeks.

Study design A PDSA cycle model for improvement was used.

Strategy for change New material and simulation sessions were launched for the second cohort of FY2-ST1s. After agreement and refinement of the educational materials by neonatal consultants, pre-induction videos were sent to the new-starters via email. Basic NLS training took place as in previous inductions, but junior-led neonatal simulation sessions were added, where each new-starter was able to take the lead in assessment and resuscitation.

Measurement of improvement To assess the efficacy and develop the educational materials, the same retrospective questionnaire will be sent to the second cohort. Verbal feedback has already suggested they were a useful introduction and made the NLS training within induction more relevant.

The junior-lead simulation scenarios were met with enthusiasm and provided a ‘safe’ forum for new starters to ask questions and practice skills.

Effects of changes Providing pre-induction material improved the effectiveness of induction for the second cohort of FY2-ST1s, and simulation sessions helped with initial skills and expectations of what may be required of them when attending deliveries. Overall these interventions are expected to improve confidence in initial newborn resuscitation, but not replace the need for senior support when requested.

There is also potential for expanding these interventions to distributing materials to and running simulation sessions with newly qualified midwives within the Trust.

The videos were widely acknowledged to be useful by various senior members of the department. There were only minor technical challenges with production of the videos.

Lessons learnt There can be a gap between trainee confidence and competence. Non-intrusive teaching resources, used either pre-induction or as a recap of skills may help to bridge this gap.

Further adaptations to neonatal pre-induction resources will be ongoing in response to feedback.

Message for others To complement inductions, providing pre-induction materials and simulation sessions is helpful in building confidence and optimising patient care in less experienced medical staff.