Board #142 - Research Abstract The Effectiveness of Instructional-design Based Simulation Scenarios for Postpartum Hemorrhage (Submission #7894)

Abstract

Hypothesis The integration of the science of learning and instruction in the field of healthcare simulation is a recognized need1 and instructional design (ID) principles emerge as interesting evidence-based guidelines for the development of this field.2 Several ID models are available such as Merrill’s First Principles of Instruction and Four-Component Instructional Design (4C/ID).3-4 Postpartum hemorrhage (PPH) is a leading cause of maternal death. Up to 80% of cases are attributable to lack of adequate training, poor communication, and insufficient teamwork.5 Simulation training is an effective tool for training complex skills particularly when instructional features are embedded.6-7 The current study aims to compare the learning outcomes of an experimental PPH simulation training based on ID principles and a typical PPH simulation scenario as described in the literature. Our hypothesis is that the experimental training has higher learning outcomes. Methods A pretest-posttest non-equivalent groups design was used. Residents from Recife, Brazil were divided into teams with 2-3 members. A PPH management protocol was constructed and the scenarios’ content was organized in eight learning constructs: communication, teamwork, vital signs, venous access, exams and mechanical, drug, and surgical managements. Each construct had several tasks to be executed. Experimental training consisted of eight steps: prior knowledge, video demonstration, protocol discussion, scenario 1, debriefing, scenario 2, debriefing with self-assessment, scenario 3. Control training consisted of three steps: prior knowledge, scenario, and debriefing. Teams from both training formats were submitted to the same pretest and posttest scenarios, which were video recorded for further analysis. The learning outcomes were compared by number of correct tasks executed at pretest and posttest, as well as the time required to execute each task and the adequateness of its execution. Results Twenty-nine residents in 13 teams attended the experimental training program, and 19 residents in seven teams attended the control training. Training formats were in-situ, with part-task PPH simulator and standardized patient. For learning outcomes comparison between the diferent training formats the number of executed tasks, per construct, per team of residents will be analyzed. In addition, time taken to execute each task and adequateness of task execution (5-point Likert scale) will be measured. The video-recorded pretest and posttest scenarios, for both training formats, will be analyzed by two different experienced and certified OBGYN. While full results will be presented during IMSH2015, we currently present a preliminary analysis of the mean proportions of executed tasks at pretest and posttest of the experimental training (Table 1). The means show a significant increase for the following constructs: communication, teamwork, venous access, exams, and drug management. Conclusion The findings demonstrate an increase in learning outcomes for OBGYN residents on the management of PPH scenarios, after following a training format that is based on ID principles. The increase was statistically significant in constructs considered important for the management of complex clinical cases, such as communication, teamwork, venous access, exams and drug management. For constructs on which a statistically significant difference was not demonstrated (vital signs, mechanical management, surgical management), one possible explanation may be the small number of tasks at the scenarios. Therefore, further analysis of data, such as time to execute tasks and adequateness of executions, may contribute to further explaining present findings. These additional analyses and future comparisons between findings from the experimental model of PPH simulation training to the control training may also add to the current body of knowledge regarding the proper design of simulation-based training.