Changing the Landscape of Obstetric Resident Education in LMIC Using Simulation Based Training [37G

Abstract

INTRODUCTION: Maternal mortality continues to be one of the largest health burdens in reproductive-aged women in low- and middle-income countries (LMIC). Simulation-based training (SBT) has been previously piloted demonstrating that SBT was an accepted method of teaching skills for managing high-risk labor in LMIC. METHODS: An in-country simulation based education course on the management of post-partum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) were provided to three major governmental teaching hospitals in Guatemala City, Guatemala. Participants were 46 OB/GYN residents. A paired Student t-test was conducted to compare clinical knowledge regarding these obstetric emergencies at three timepoints: before SBT, one week, and six months after SBT. RESULTS: There was significant increase in scores in clinical knowledge of SD and MCA one week (M=7.83, SD=1.1) following SBT compared to baseline (M=5.96, SD=1.75); P≤.05. However, for PPH there was no increase in scores one-week (M=2.91, SD=0.94) following SBT compared to baseline (M=2.73, SD 0.65); P>.05. Additionally, the difference in scores was maintained at six months following SBT for SD and MCA (M=7.52, SD=1.09) compared to baseline (M=5.96, SD=1.75); P≤.05. PPH scores at six-months (M=3.36, SD 0.65) showed a significant increase compared to baseline (M=2.73, SD=0.65); P≤.05. CONCLUSION: Simulation-based training was found to be an effective method to increase cognitive clinical knowledge in LMIC for rarely seen events of MCA and SD but not with the more common event of PPH. This knowledge increase was maintained six-months after participation in the training.