Contextually relevant factors within a training environment facilitate performance transfer to applied
clinical settings. Live animals are often used for pediatric and neonatal intubation training because the scale of their
airways and the living condition of the animal are assumed to facilitate transfer of aquired skills to intubating infants
and children, despite species-specific anatomical variation. Mannequin simulators provide an alternative for training,
but have anatomical, physiological, and tissue limitations. We evaluated the impact of two clinical training methods
(live animal v. simulation) on the acquisition of performance abilities in pediatric and neonatal intubation. Methods:
We implemented a quasi-experimental design with purposive sampling to assess performance differences between
294 subjects after completing a training intervention that included either direct interaction with a (1) live animal or
(2) mannequin simulator. All other training elements were identical and followed American Heart Association
(PALS/NRP) clinical protocols. We used validated instruments to assess knowledge, performance, and self-efficacy
outcomes before and after training, and at three retention intervals (6, 18, and 52 weeks). Results: Post-training
outcomes were significantly better that pre-training outcomes for both groups (p < .001), and there were no
significant differences between the outcomes for the two types of training. There were significant differences
between the performance outcomes after 18 and 52 weeks (p < .01), and for cognitive outcomes after 52 weeks (p <
.01), all favoring the simulator training. Conclusions: These findings could aid in the selection of instructional
methodologies that minimize the uses of live animals for instruction in pediatric and neonatal intubation without
sacrificing the quality of training. Variation in retention outcomes are likely due to opportunity for repeated
deliberate practice using a simulator rather than associated with fidelity issues. Improvements in simulator
technology would likely improve training outcomes.