High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

J Perinatol. 2012 Apr;32(4):287-92. doi: 10.1038/jp.2011.96. Epub 2011 Oct 27.


Objective: Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees.

Study design: Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made.

Result: The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P=0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups.

Conclusion: Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Arousal / physiology
  • Clinical Competence
  • Computer Simulation*
  • Cross-Over Studies
  • Fellowships and Scholarships*
  • Female
  • Humans
  • Hydrocortisone / blood
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Models, Anatomic*
  • Neonatology / education*
  • Perinatology / education*
  • Prospective Studies
  • Resuscitation / education*
  • Resuscitation / instrumentation*
  • Stress, Psychological / complications


  • Hydrocortisone