Time perception | ‘It’s easy to go back, it’s harder to go back and think about what you think, because time is so skewed and like when you’re doing a resuscitation. So it’s nice to be able to go back and see how long each thing took’. (PHCP17) |
Discussing approaches | ‘Yes, and discussing, I mean, there is so much uncertainly in neonatology that I think, you know, just discussing different ways to approach the same situation inevitable is part of our field. Cause there are a lot of things where it’s grey and you don’t know what the right way to do would have been’. (PHCP14) |
Crew resource management | ‘I mean if you think about it, and again, it’s not exact the same thing, but like, in airplanes, like the black box, like things like that, it’s a recording of everything that happens on the plane and it’s reviewed. And I think that that is again invaluable for figuring out when things go wrong, how things go wrong. And so I think that it could also be from, like when things do go wrong, like are there system things that we can change? Are there personnel things that need to be changed?’ (PHCP15) |
Internalise protocol | ‘From an educational standpoint how it helps me is in the sense of just sort of following the steps of resuscitation, dry, stem, stimulation. How to give PPV. Sort of how to think about what the next steps are’. (PHCP12) |
Exposure | ‘Well, residents for instance, they can see how other people perform during resuscitation, and they can take things away from that. Because your exposure as a resident is relatively low, as you are not on service all the time. And oftentimes you do not even get the chance to perform an intubation at all, as we are trying to be non invasive, and as such you can see how a intubation is performed. Your exposure increases, as you can see more. Normally, you would only see like twenty resuscitations a year, of which one or maybe five include intubation. But by reviewing you can actually see it five times more’. (LHCP16) |
Data collection | ‘And I think it’s like an unique opportunity for research, because it’s so unusual. Like all the things that men might want to study in the NICU, like, we don’t usually have video, like primary source. We could actually look and know like what was done and what the vital signs were at that moment. Like that’s I think a pretty unusual opportunity, so to have that and to be able to use that for research is, is a pretty powerful tool’. (PHCP14) |
Communication skills | ‘But even how you communicate, the words you use, the tone you have, the way you instruct people, the way you give feedback or ask people to do things, are all things that, that you know, it’s a lot of that communication and personal, you know personal style or communication skills that watching the video allows you to understand that better than you would just trying to recall that’. (PHCP24) |
Documentation | ‘But in my opinion this has more to do with being trained in reviewing those moments, so you can actually be more aware of how to document and how to reflect on those decisions that in retrospect turn out to be important for the whole process’. (LHCP10) |
Reassurance | ‘So, afterwards, I, the whole team sat down and we looked at it again. […] I think we were all kind of feeling, like afterwards, is there more that we could have done differently, you know, would the outcome have been different. And so I think it was helpful for us to sit down and look at it and, you know, talk about little things we might have done differently, but, you know, in the end it was like, I don’t know if there was anything we really could have done that would have ultimately have made so that baby survived. But it was helpful to have the video as a tool to go back and not just rely on our memories of what happened’. (PHCP14) |
Respiratory functioning monitor | ‘It needs a few resuscitations and a few audits to understand how to interpret those numbers and graphs. A lot of it is pattern recognition, so it’s helpful if you are telling us, well, this is what we can see now. This is the pattern. And if you see that pattern recur, so yesterday night I saw this pattern and I thought, oh, these are good tidal volumes, I can see air getting in the airways, I do not see obstruction, I do not see leakage. Those patterns you learn to recognize and this helps you to read the monitor’. (LHCP20) |
Self-awareness | ‘Or, watched yourself on a video, it’s, you see a lot of your own manners and some of them make you cringe, but you also notice things, like either during a resuscitation a kid was fine, but I kept on turning my head and getting distracted by other things and not focusing on the kid in front of me. Even though he was fine, but it just, it just, it reminded me how distracted I get by everything else in the room. And so with things like I think it can be a really good tool’. (PHCP15) |
Self-improvement | ‘If you do not do the audit, you don’t know. You do not get that feedback. Maybe you would feel better, but, well, somehow you are unconsciously incompetent. And of course, it’s easier to be unconsciously incompetent than consciously incompetent. But, in the end it’s better for everybody, for your patient, but as well for yourself, to have been made aware about things you did suboptimal. […] And there are definitely things I learned and that I would do differently later on or still do differently than I did at that moment’. (LHCP21) |
Role differentiation | ‘I think the, just like less people touching, just being a bit more specific about the roles themselves. Before this, we’ve been very, it was very vague. It was just, I’m the leader and I’m the airway and I’m the this and I’m the that. But we weren’t very clear about what is it I want you to do in that role. And so, you know, that’s, that’s been helpful’. (PHCP25) |
Physiology | ‘And you need to know a lot about physiology, that you do know as a neonatologist, but to put this knowledge into practice may not be this obvious for everyone. […] But you do learn how to do that by reviewing these videos. […] And as this is taught during review, you learn a lot about the physiology of transition at birth’. (LHCP21) |
Protocol compliance | ‘And that’s one of the biggest things I’ve seen in the program, is, and we know it all along, but every one of these resuscitations, the steps take a lot longer, or are instituted a lot later than what you think. And so this, this says, let’s get these steps in order and do them in a quick fashion’. (PHCP10) |
Keeping knowledge up to date | ‘I think everybody has room for improvement. No matter how much experience people have and, with the way like in health care things constantly are changing, I think like, you know, just staying up-to-date with the current procedures and policies. So I think it’s helpful’. (PHCP6) |
Protocol establishment | ‘I think, I think just the, it really, one is, like it facilitates an open discussion on how we perform our resuscitation and how we can do things better […] But then we also say like how, like we identify this, how is the division gonna adjust this?’ (PHCP7) |