BACKGROUND Telesimulation (TS) addresses barriers to delivering simulation training in rural environments. We implemented a longitudinal TS program, Maine Ongoing Outreach Simulation Education (MOOSE), across 5 hospitals. We aimed to improve team adherence to the Neonatal Resuscitation Program (NRP) and assess the impact of team composition and training intervals. METHODS Teams at 5 hospitals participated in monthly TS. TS recordings were assessed for adherence to NRP. NRP adherence was regresse