Take home point
With a small group of pediatric residents and fellows (n=20), researchers in Ireland at University at Cork University Maternity Hospital demonstrated in an article that an iPhone educational app used at the patient bedside is a useful tool for increasing the performance of newborn intubation.
Smartphones were also useful for increasing knowledge of newborn intubation among trainees.
Whether smartphones can be used to enhance teaching of clinical skills is not known. This study sought to assess whether the use of a smartphone neonatal intubation instructional app call NeoTube improved trainee knowledge and procedural skills. As part of their rationale for using a smartphone in this context, the researchers note in their article that cell phones have been useful for improving calculation performance and reducing errors by clinicians.
Approach to Address Problem
Researcher used a pre-post study design. Neonatology and pediatric trainees who were Neonatal Resuscitation Program certified completed a questionnaire to assess their knowledge of neonatal intubation. The questionnaire was based on the Neonatal Resuscitation Program 2010 guidelines and asked the trainees about indications, complications and equipment required for neonatal intubation.
After filling out the questionnaire, they were asked to intubate a newborn manikin model. This was viewed as their baseline knowledge prior to using the NeoTube app. The trainees were then given the NeoTube app to review for 15 minutes and asked to complete the questionnaire again along with intubating the manikin. Pre and post questionnaires were scored and compared. The intubations were video recorded digitally. Then, they were scored randomly by National Resuscitation Program assessors unaware of whether they were looking at intubations pre or post the NeoTube app.
This study’s innovation was the inclusion of the app for a short period of time in order to quickly influence the knowledge of the trainee instead of letting the trainees spend more time learning about intubation from the app similar to a classroom setting. This approach mimics the fast paced learning environment of trainees who may need quick refreshers in how to perform certain procedures prior to doing them in order to decrease the potential for errors.
12 neonatology fellows and 8 pediatric residents participated in the research study. 7 of the participants had used the app before which may have decreased the impact of the intervention on them. There was a significant increase (p<.0001) in the questionnaire scores for residents and fellows demonstrating a change in knowledge as a result of using the app. This seems to be a demonstration that the app provided them with short term information that matched the questions posed in the questionnaire. This is only useful if the questionnaire is relevant to the actual intubation of newborns. This appears to be the case because the researchers also saw a significant increase in the skill score of trainees overall (p=.016).
However, this change for the entire group disappeared when looking at residents and fellows separately. A significant change was not seen in skill scores for the pediatric fellows who had more experience intubating newborns than the residents. The duration of the intubation decreased with no significant difference for each group but a significant difference when both groups were combined (p=.044).
Implications for clinicians/health care system
The study demonstrates that smartphones may have a useful role in increasing the performance of newborn intubation and similar procedural clinical skills which are done at the bedside. In particular, smartphone apps may be useful for procedural skills that clinicians do not perform regularly and thereby need a brief refresher course prior to performing the procedure. Also, as new research on the procedure arises, an app of this nature could incorporate any new safety standards which update their method for performing such procedures.
Implications for public health
The primary implication for public health is that quality of care may be improved for newborns who need intubating if the NeoTube app is utilized by trainees. However, more research is needed before the true potential impact on the public health is known. Also, the study does not provide any information about how this app would impact clinicians who are highly skilled, who also may need a refresher if they have not intubated a newborn within a certain period of time (perhaps 6 months to a year).
Future research concerns/challenges
The main future concern for this area of research is replicating the findings in a larger group of trainees. A second concern is comparing the use of a NeoTube app to other teaching methodologies with or without a smartphone. For example, current courses used to certify trainees by the National Resuscitation Program could be converted into an app which may be more useful. Whether the smartphone as a tool is somehow more efficient at conveying information compared to other user friendly modalities is not clear from this study and requires more attention in the future.