641: Improving shoulder dystocia management among resident and attending physicians using simulations

Abstract

Previous studies have found improved resident performance in shoulder dystocia (SD) management through the use of medical simulations. We sought to determine if a similar program would improve our physicians’ performance regardless of experience level. Physicians involved in obstetrical care at our institution (n=71) participated in an unanticipated simulated SD followed by an educational session. At a later date, all completed a second SD simulation. Each simulation was scored by 2 physician observers, based on a standardized checklist for 6 communication tasks (e.g. asks for assistance, takes leadership role, communicates to arriving help) and 4 technical maneuvers (McRoberts, suprapubic pressure, gentle downward pressure, advanced maneuvers). Overall quality of provider performance was scored using a 5-point Likert scale (5=excellent). Paired Student’s t tests were used for analysis. 71 subjects, 43 attendings and 28 residents, participated. Ages ranged from 25-63 years (37.0 ± 9.0) and 75% were female. Years of obstetrical experience ranged from 4-31 years (14.5 ± 8.1) for attendings. 43% of residents and 16% of attendings had prior simulation experience. Overall performance scores and communication scores are improved in the second simulation for providers at all experience levels (Table).Tabled 1Comparing SD management pre and post simulationsPrePostp valueCommunication Resident3.5 (1.2)4.9 (1.0)<0.0001 Attending3.6 (1.6)4.9 (1.1)<0.0001Maneuvers Resident3.3 (0.9)3.9 (0.4)0.001 Attending3.8 (0.5)3.9 (0.3)NSOverall Resident2.4 (1.0)3.8 (0.9)<0.0001 Attending3.4 (0.9)4.1 (0.7)<0.0001 Open table in a new tab Our simulation program improved the overall quality of physician performance in the management of SD. Simulation training can improve communication skills crucial for the management of obstetric emergencies. Simulation exercises should become a routine part of maintaining the proficiency of labor and delivery personnel.