Remote versus in-person pre-service neonatal resuscitation training: A noninferiority randomized controlled trial in Ethiopia

Abstract

Background

In-person neonatal resuscitation training in resource-limited settings faces barriers of geographic access, facilitator and participant availability, and high costs. Remote training could overcome these challenges while maintaining effectiveness. We hypothesized that remote neonatal resuscitation training was noninferior to in-person training for acquiring and retaining knowledge and skills for pre-service education in Ethiopia.

Methods

We conducted a randomized, controlled, noninferiority trial comparing remote versus in-person neonatal resuscitation training in Jimma, Ethiopia. Medical students without prior resuscitation training were randomized (1:1) to Zoom or in-person delivery of the Helping Babies Breathe curriculum supplemented with videos. Outcome assessors were unmasked, but investigators not involved in participant recruitment remained masked. The primary outcome was neonatal resuscitation skills assessed by the Objective Structured Clinical Examination B (OSCE B) two months after training. The noninferiority margin was 13%. Group differences were assessed by intention-to-treat analysis using one-sided t-tests. A p-value < 0.05 suggests noninferiority. The trial was registered at Clinicaltrials.gov, NCT05854745, and is complete.

Results

Between May 1-June 4, 2023, 354 medical students were randomized to remote or in-person training (177 per group). 262 attended the training and completed assessments (remote n = 123, in-person n = 139; 51% male overall). Two months after training, 199 participants completed assessments (remote n = 94, in-person n = 105). Mean OSCE B scores were 19.8 (SD 3.24) in the remote group and 20.5 (SD 2.24) in the in-person group (difference −0.76 [95% CI −1.53 to 0.01]; p < 0.001 for noninferiority), with similar passing rates (remote 62.8%, in-person 60.0%). No adverse events occurred.

Conclusion

Remote training achieved noninferiority to in-person training in resuscitation skill retention at two months among medical students with minimal resuscitation experience, suggesting an effective and promising approach to expanding essential clinical training access globally in resource-limited settings.