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Editor—The Royal College of Paediatrics and Child Health produced recommendations on teaching and training junior doctors involved in neonatal resuscitation.1 These stated that all new staff members should receive an induction programme on neonatal resuscitation that includes practice with mannequins. All should also be familiarised with resuscitation equipment on labour wards and be appraised before being permitted to operate alone. Regular updates on neonatal resuscitation training are also recommended and ideally all junior staff's participation in resuscitation procedures should be formalised and documented.
We attempted to assess by telephone questionnaire the current position of neonatal resuscitation training in England and Wales, using a questionnaire of general professional trainees (GPTs). The questionnaire covered key areas within the college recommendations. An attempt within the questionnaire was made to assess the previous neonatal experience of the GPT respondents. A single GPT in each unit was interviewed by telephone. The survey was conducted from October 1999 to January 2000 (the latter part of most attachments). Two hundred and nine units were identified as units with paediatric Senior House Officer cover. One hundred and seventy seven GPTs successfully completed the questionnaire (85%). None contacted were unwilling to participate (some were busy while on duty and others did not answer within three attempts).
Most units (94%) provide a formal theoretical session on neonatal resuscitation during induction (table 1). 86% of units provided practical skills training at induction including endotracheal intubation. Training on practical skills of attaining vascular access in a compromised neonate was undertaken in just 44% of units although 90% of the GPTs were taught on resuscitaire function and set up. Not all units provided 24 hour registrar cover on site with 12% of respondents attending deliveries with consultant cover. Only one third (31%) of GPTs interviewed were accompanied by a consultant or registrar until they achieved their first successful intubation (although it was widely accepted that this was difficult to achieve, especially in some units). Three quarters (75%) did not receive a formal in-post appraisal or test of skills before they were left alone. Post induction training was provided to less than half of respondents (45%) although across the experience range 71% of trainees had already attended (or been encouraged to attend) a course on neonatal resuscitation. Two thirds (69%) of the trainees had little previous neonatal experience in the UK.
When regional units were compared with district general units, training in attaining vascular access appeared to be common in regional units (84% v 39%) along with higher chance of formal appraisal before being left alone for resuscitation (47%v 22%). District general hospitals provided more encouragement to attend courses (73% v53%) but had fewer trainees with previous experience.
Resuscitation training includes induction with didactic teaching, practical skills training, and ongoing assessment of performance. In an ever changing situation of GPT education, our results need to be interpreted with caution but nevertheless, we believe, reflect current concerns about experience and education offered to neonatal trainees, which will hopefully to be addressed by the Neonatal Life Support Course.
This study indicates that some, but not all, units meet the standards encompassed within the Royal College guidelines. In 1993 Barrie also recorded considerable variation in the delivery of such training in a Northwest area.2 This study reveals an identical problem right across England and Wales.
We hope the new neonatal life support will address many of the issues raised within the area of training of GPTs, but universal and mandatory attendance of this is necessary if standards of newborn resuscitation are not to vary unacceptably across England and Wales. We believe this aspect of care should be the subject of quality assurance when assessing the capacity of individual units to provide care in the future.
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