Health care professionals practicing in rural and critical access hospitals face a great diversity of clinical problems but often only have access to limited support. Geographic boundaries can construct barriers to continuing professional development. In addition, neonatal emergencies may arise infrequently at any given location. Thus, to improve neonatal resuscitation outcomes, particularly at remote and rural sites, it is likely necessary to increase the frequency with which physicians and staff are provided with hands-on simulation and team training to minimize decay. The presence of an instructor who is able to structure simulation experiences to facilitate deliberate practice, targeted assessment, feedback, and reflection may be a critical component of effective simulation, but these expert instructors typically reside in larger centers. Telesimulation, with video linkage to an expert consultant in the field, provides an opportunity for health care professionals in rural or critical access hospitals to support their own continuing education simulation curriculum.

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