Date of Award

10-18-2025

Degree Type

Thesis

Degree Name

Master of Health Professions Education (MPHE)

First Advisor

Dr Sana Saeed

Second Advisor

Dr Shaista Afza

Third Advisor

Professor Raheela Yasmin

Department

Educational Development

Abstract

Background: Effective neonatal resuscitation starts well before the baby is born. Preparation in the delivery room is crucial, yet there is no validated tool that assesses how well paediatric residents prepare to receive a neonate at birth. Existing checklists often miss to assess the quality and completeness of these critical steps. This study aimed to develop and validate the Neonatal Birth Readiness Assessment Tool (Neo-BRAT), a structured, competency-based assessment tool to address this gap.
Method: It was a tool validation study, conducted at Department of Paediatrics, The Aga Khan University, Pakistan. This study used a sequential mixed-method design, beginning with a qualitative consensus phase (modified Delphi) to establish content validity (expert consensus[1]from neonatologists, paediatricians, nurses, and medical education experts), followed by a quantitative phase to test reliability and construct validity. The final version of Neo-BRAT included 13 items under four domains; 1) initial assessment, 2) thermoregulation and vital monitoring, 3) airway clearance and respiratory support and 4) in case of high-risk delivery which might require intubation. Three clinical raters independently assessed 41 paediatric residents (Years 1–4) using simulation-based scenarios. Validity evidence on content, response process and internal structure was gathered using Messick’s framework. Performance of junior residents (year 1 & 2) and senior residents (Year 3 &4) were compared both for item-based scores and global rating scale using Mann–Whitney U tests. P value of < 0.05 was taken as significant. SPSS version 20.0 was used to analyse the data.
Results: All items (n=13) received full agreement (I-CVI and S-CVI/Ave = 1.0) on relevance, clarity and comprehensiveness. A total of 41 paediatric residents were assessed using the Neo-BRAT tool, comprising 28 juniors (years 1–2) and 13 seniors (years 3–4). The Neo-BRAT showed good internal consistency (Cronbach’s α = 0.796) and acceptable overall inter-rater reliability (ICC = 0.735). Seniors significantly outperformed juniors on key items, including maternal history (p = 0.016), hand hygiene (p = 0.001), personnel identification (p = 0.022), and thermoregulation (p = 0.021). The overall mean score was significantly higher for seniors (p = 0.002).
Conclusion: The Neo-BRAT is a valid and reliable tool for assessing paediatric residents' preparedness to receive neonates at birth. It offers more than a checklist—by capturing both technical and behavioural competencies, it provides meaningful insights on the quality of resident performance. With further refinement and broader testing, it has the potential to improve clinical training, guide feedback, and support better outcomes in neonatal care

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Last Page

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