Long-Term Skills Retention After Obstetric Simulation Training for Skilled-Birth Attendants in Rural Rwanda [9D

Abstract

INTRODUCTION: The World Health Organization advocates for the presence of attendants at every birth skilled at managing normal pregnancies and obstetrical complications. We aimed to evaluate the long-term skills retention gained by skilled birth attendants (SBAs) who completed a spontaneous vaginal delivery (SVD) and postpartum hemorrhage (PPH) simulation-training program. METHODS: A pre-post intervention study was conducted with a convenience sample of SBAs in rural Rwanda. Two separate groups of SBAs underwent initial simulation training with pre- and immediate post-testing. Group A had training in February 2013. Group B had training in February 2014. Simulation drills to assess skill retention were conducted in September 2015 for both groups. Participants were scored on communication, evaluation, and management skills. Median scores were calculated and the Wilcoxon signed-rank sum test compared the pre-training, post-training, and retention scores. RESULTS: 68% (13/19) of SBAs in Group A and 53% (8/15) SBAs in Group B were available for the skill-retention evaluation. There were no demographic, experiential, or educational differences between groups. After training, both groups showed immediate improvement in almost all the areas evaluated. At 2 years, Group A showed significant falls in their scores in three of the areas evaluated while group B at 1 year demonstrated a decline in only one of the areas evaluated. CONCLUSION: Simulation training is an effective method for acquisition of SVD and PPH skills in low resource settings. Most skills were retained 1 year after the initial training, but lost after 2 years, which suggests that training should be conducted on a yearly basis.