Change in Knowledge of Midwives and Obstetricians Following Obstetric Emergency Training: A Randomized Controlled Trial of Local Hospital, Simulation Centre and Teamwork Training

Abstract

Surveys in the United Kingdom have repeatedly discovered substandard care in significant proportions of maternal, fetal, and neonatal deaths. In the United Kingdom, training in obstetrical emergencies is carried out both nationally and locally in maternity units. This prospective, randomized controlled trial evaluated training in 6 hospitals in the United Kingdom. The 140 participants included 22 junior and 23 senior doctors as well as 47 junior and 48 senior midwives. They were randomized to one of 4 obstetrical emergency training interventions: a 1-day course at a local hospital, a 1-day course at a simulation center, a 2-day course with teamwork training at a local hospital, and a 2-day course with teamwork training at a simulation center. A 183-question multiple choice questionnaire (MCQ) was completed up to 3 weeks before the training intervention and again 3 weeks after the intervention. All but 7 of the 140 participants completed training and the posttraining assessment. Knowledge of obstetrical emergency management increased following training. The increase in the mean MCQ score was significant at the P < 0.001 level. All but 10 of 133 participants who completed both assessments had increased MCQ scores. Neither the location of training nor the inclusion of teamwork training significantly influenced posttraining scores. Changes in MCQ scores after training correlated negatively with pretraining scores. There were, however, no significant differences between staff groups in their relative responses to the 4 training interventions. With one exception—management of breech presentation—scores for individual components of the MCQ improved significantly. This is the first study demonstrating objective improvement in what doctors and midwives know following training in obstetrical emergency management. It remains to be determined whether this translates into lower maternal and neonatal morbidity and mortality rates. The investigators believe that all relevant staff should take part in this type of training on an annual basis.