Curriculum and assessment tool for less invasive surfactant administration: an international Delphi consensus study

Background Training and assessment of operator competence for the less invasive surfactant administration (LISA) procedure vary. This study aimed to obtain international expert consensus on LISA training (LISA curriculum (LISA-CUR)) and assessment (LISA assessment tool (LISA-AT)). Methods From February to July 2022, an international three-round Delphi process gathered opinions from LISA experts (researchers, curriculum developers, and clinical educators) on a list of items to be included in a LISA-CUR and LISA-AT (Round 1). The experts rated the importance of each item (Round 2). Items supported by more than 80% consensus were included. All experts were asked to approve or reject the final LISA-CUR and LISA-AT (Round 3). Results A total of 153 experts from 14 countries participated in Round 1, and the response rate for Rounds 2 and 3 was >80%. Round 1 identified 44 items for LISA-CUR and 22 for LISA-AT. Round 2 excluded 15 items for the LISA-CUR and 7 items for the LISA-AT. Round 3 resulted in a strong consensus (99–100%) for the final 29 items for the LISA-CUR and 15 items for the LISA-AT. Conclusions This Delphi process established an international consensus on a training curriculum and content evidence for the assessment of LISA competence. Impact This international consensus-based expert statement provides content on a curriculum for the less invasive surfactant administration procedure (LISA-CUR) that may be partnered with existing evidence-based strategies to optimize and standardize LISA training in the future. This international consensus-based expert statement also provides content on an assessment tool for the LISA procedure (LISA-AT) that can help to evaluate competence in LISA operators. The proposed LISA-AT enables standardized, continuous feedback and assessment until achieving proficiency.


Introduction 5
Background 2 Provide a background about the rationale of study, what has been previously done, and why this survey is needed.

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Purpose/aim 3 Identify specific purposes, aims, goals, or objectives of the study. 5

Methods 6
Study design 4 Specify the study design in the methods section with a commonly used term (e.g., cross-sectional or longitudinal). 6 5a Describe the questionnaire (e.g., number of sections, number of questions, number and names of instruments used).

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Data collection methods 5b Describe all questionnaire instruments that were used in the survey to measure particular concepts. Report target population, reported validity and reliability information, scoring/classification procedure, and reference links (if any). 6 5c Provide information on pretesting of the questionnaire, if performed (in the article or in an online supplement). Report the method of pretesting, number of times questionnaire was pre-tested, number and demographics of participants used for pretesting, and the level of similarity of demographics between pre-testing participants and sample population.

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5d Questionnaire if possible, should be fully provided (in the article, or as appendices or as an online supplement).

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Sample characteristics 6a Describe the study population (i.e., background, locations, eligibility criteria for participant inclusion in survey, exclusion criteria).

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6b Describe the sampling techniques used (e.g., single stage or multistage sampling, simple random sampling, stratified sampling, cluster sampling, convenience sampling). Specify the locations of sample participants whenever clustered sampling was applied.
6 6c Provide information on sample size, along with details of sample size calculation. NA 6d Describe how representative the sample is of the study population (or target population if possible), particularly for population-based surveys.
NA Survey administration 7a Provide information on modes of questionnaire administration, including the type and number of contacts, the location where the survey was conducted (e.g., outpatient room or by use of online tools, such as SurveyMonkey).
7b Provide information of survey's time frame, such as periods of recruitment, exposure, and follow-up days. 6 7c Provide information on the entry process: ->For non-web-based surveys, provide approaches to minimize human error in data entry.
->For web-based surveys, provide approaches to prevent "multiple participation" of participants.
8 Study preparation 8 Describe any preparation process before conducting the survey (e.g., interviewers' training process, advertising the survey). 9b Provide information about survey anonymity and confidentiality and describe what mechanisms were used to protect unauthorized access.

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Statistical analysis 10a Describe statistical methods and analytical approach. Report the statistical software that was used for data analysis.

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10b Report any modification of variables used in the analysis, along with reference (if available).

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10c Report details about how missing data was handled. Include rate of missing items, missing data mechanism (i.e., missing completely at random [MCAR], missing at random [MAR] or missing not at random [MNAR]) and methods used to deal with missing data (e.g., multiple imputation).

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10d State how non-response error was addressed. 9 10e For longitudinal surveys, state how loss to follow-up was addressed. NA 10f Indicate whether any methods such as weighting of items or propensity scores have been used to adjust for non-representativeness of the sample.

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10g Describe any sensitivity analysis conducted. NA

Results 10
Respondent characteristics 11a Report numbers of individuals at each stage of the study. Consider using a flow diagram, if possible.

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11b Provide reasons for non-participation at each stage, if possible. NA 11c Report response rate, present the definition of response rate or the formula used to calculate response rate.

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11d Provide information to define how unique visitors are determined. Report number of unique visitors along with relevant proportions (e.g., view proportion, participation proportion, completion proportion).

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Descriptive results 12 Provide characteristics of study participants, as well as information on potential confounders and assessed outcomes.

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Main findings 13a Give unadjusted estimates and, if applicable, confounder-adjusted estimates along with 95% confidence intervals and p-values.

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13b For multivariable analysis, provide information on the model building process, model fit statistics, and model assumptions (as appropriate).

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13c Provide details about any sensitivity analysis performed. If there are considerable amount of missing data, report sensitivity analyses comparing the results of complete cases with that of the imputed dataset (if possible).

Discussion 13
Limitations 14 Discuss the limitations of the study, considering sources of potential biases and imprecisions, such as non-representativeness of sample, study design, important uncontrolled confounders.

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Interpretations 15 Give a cautious overall interpretation of results, based on potential biases and imprecisions and suggest areas for future research.

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Generalizability 16 Discuss the external validity of the results. 13-14

Other sections
Role of funding source 17 State whether any funding organization has had any roles in the survey's design, implementation, and analysis.

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Conflict of interest 18 Declare any potential conflict of interest. 24