Changing the landscape of obstetric resident education in low- and middle-income countries using simulation-based training.

Abstract

To evaluate simulation-based training (SBT) in low- and-middle-income countries (LMIC) and the long-term retention of knowledge and self-efficacy. We conducted an SBT course on the management of postpartum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) in three government teaching hospitals in Guatemala. We evaluated changes in knowledge and self-efficacy using a multiple-choice questionnaire for 46 obstetrics/gynecology residents. A paired Student's t test was used to analyze changes at 1week and 6months after the SBT. There was an increase in scores in clinical knowledge of MCA (p<0. 001, 95% confidence interval [CI] 0.81-1.49) and SD (p<0.001, 95% CI 0.41-1.02) 1week after SBT, and a statistically insignificant increase in PPH scores (p=0.617, 95% CI -0.96 to 0.60). This increase in scores was maintained after 6months for MCA (p<0.001, 95% CI 0.69-1.53), SD (p=0.02 95% CI 0.07-0.85), and PPH (p=0.04, 95% CI 0.01-1.26). For MCA and SD, the levels of self-efficacy were increased 1week following training (p<0.001, 95% CI 0.83-2.30 and p=0.008, 95% CI 0.60-3.92, respectively), and at 6 months (p<0.001, 95% CI 0.79-2.42 and p=0.006, 95% CI 0.66-3.81, respectively). There was a slight increase in PPH self-efficacy scores 1 week after SBT (p=0.73, 95% CI -6.05 to 4.41), maintained after 6months (p=0.38, 95% CI -6.85 to 2.85). SBT was found to be an effective and feasible method to increase short- and long-term clinical knowledge and self-efficacy of obstetric emergencies in LMIC.