• Lindsay Johnston, Taylor Sawyer, Akira Nishisaki, Travis Whitfill, Anne Ades, Heather French, Kristen Glass, Rita Dadiz, Christie Bruno, Orly Levit, Sandeep Gangadharan, Daniel Scherzer, Ahmed Moussa, Marc Auerbach, and INSPIRE Research Network.
• Department of Pediatrics (L Johnston,T Whitfill, C Bruno,O Levit, and M Auerbach), Yale University School of Medicine, New Haven, Conn. Electronic address: Lindsay.johnston@yale.edu.
• Acad Pediatr. 2019 Mar 1; 19 (2): 157-164.

BackgroundNeonatal tracheal intubation (NTI) is an important clinical skill. Suboptimal performance is associated with patient harm. Simulation training can improve NTI performance. Improving performance requires an objective assessment of competency. Competency assessment tools need strong evidence of validity. We hypothesized that an NTI competency assessment tool with multisource validity evidence could be developed and be used for formative and summative assessment during simulation-based training.MethodsAn NTI assessment tool was developed based on a literature review. The tool was refined through 2 rounds of a modified Delphi process involving 12 subject-matter experts. The final tool included a 22-item checklist, a global skills assessment, and an entrustable professional activity (EPA) level. The validity of the checklist was assessed by having 4 blinded reviewers score 23 videos of health care providers intubating a neonatal simulator.ResultsThe checklist items had good internal consistency (overall α = 0.79). Checklist scores were greater for providers at greater training levels and with more NTI experience. Checklist scores correlated with global skills assessment (ρ = 0.85; P < .05), EPA levels (ρ = 0.87; P < .05), percent glottic exposure (r = 0.59; P < .05), and Cormack-Lehane scores (ρ = 0.95; P < .05). Checklist scores reliably predicted EPA levels.ConclusionsWe developed an NTI competency assessment tool with multisource validity evidence. The tool was able to discriminate NTI performance based on experience. The tool can be used during simulation-based NTI training to provide formative and summative assessment and can aid with entrustment decisions.Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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