Introduction Competence in neonatal resuscitation is often assumed on the basis NLS provider status or previous experience. For trainees commencing a neonatal post this assumption may be unreliable.

Methods Junior (ST1-3) and senior (ST4+) trainees with the Leicester Neonatal Service either (re)certified as NLS providers or received a standardised resuscitation assessment. Assessments used:

• ▶ ST1-3 assessment focusing on basic life support skills and airway positioning.

• ▶ ST4+ assessment: meconium aspiration, focusing on advanced life support, including intubation of a mannequin.

These were performed on delivery suite using standard equipment by two experienced NLS instructors and prospectively recorded on a standardised criterion-referenced proforma. Failure at the first assessment resulted in repeat assessment. Resuscitation records from 2003 to 2010 were independently reviewed by two assessors. Reasons for failure were classified as algorithm, technical or both.

Results 262 assessments were performed. 98/160 (61%) of junior trainees and 57/102 (56%) of senior trainees passed their first assessment. The pass rate remained constant over the period studied. 43/62 (69%) juniors and 40/45 (89%) seniors were reassessed with a 79% and 85% pass rate respectively. Junior first fails were 23% algorithm, 34% technical, 43% both while senior were 20%, 27% and 53%.

Conclusions A significant portion of trainees previously trained in neonatal resuscitation failed a standardised assessment. Assessment itself is a powerful extrinsic motivating factor as demonstrated by a high reassessment pass rate. Units should consider re-evaluating trainees' competency at the start of a neonatal post.