Neo RQI: Evaluating the Effect of Neonatal Resuscitation Quality Improvement Cart Booster Training on Provider Positive Pressure Ventilation Skills Retention

a prospective, multicenter, parallel, randomized controlled trial will be conducted. any nRP (neonatal Resuscitation Program) card carrying provider is eligible to be included in the study. all study subjects will undergo training at standardized instructor led positive pressure ventilation (PPV) skills station. Their PPV skills will be assessed before and after the instructor led skills training. This training will minimize confounding due to variation in prior training experience. after this, study subjects will be randomized to either quarterly PPV skill booster training (BT) or no booster training (nBT). Minimization procedure will be used to prevent imbalance between the two groups for profession, experience level and proficiency. outcomes: The primary outcome of the study is the proportion of subjects who provide [Greater Than]80% ventilation with low mask leak ([Less Than] 30% mask leak) during the one-minute assessment at six months from the instructor led PPV skills training. at six and nine months, we will also compare tidal volumes achieved, composite PPV quality score and its individual domains between the two groups. We will also conduct a paired data analysis of mask leak over time using a mixed model approach. We will plan subgroup analysis based on experience level, profession and baseline proficiency in PPV skills. We will also conduct sensitivity analysis by excluding those who remained non-proficient after instructor led PPV skills training to assess true PPV skills decay.