Abstract
Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 ± 8.9 versus post: 72.8 ± 6.1, p = 0.01) and CS total scores (pre: 22.2 ± 6.4 versus post: 29.9 ± 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.
Highlights
Cardiac arrest is a rare event during pregnancy [1]
Nine residents from our institution’s Obstetrics & Gynecology (OBGYN) residency program were recruited for the study based on their availability to participate in all four simulations
Significant differences were noted in individual knowledge tests (KT) scores and confidence surveys (CS) total scores
Summary
Cardiac arrest is a rare event during pregnancy [1]. Due to advances in assisted reproductive therapy, the increasing number of pregnancies in women older than thirty-five years of age, and continued intimate partner violence globally [2], the likelihood of maternal cardiac arrest is escalating [3]. Whether cardiac arrest in pregnancy is attributed to obstetric or nonobstetric etiologies, the cause must be identified in a timely fashion and aggressively managed to improve the likelihood of successful resuscitation of both the mother and fetus. Previous research has shown simulation to be a valuable tool as a means to educate novice providers in the management of emergent obstetrical conditions [4]. Simulation has been shown to improve competence in obstetric emergency decision-making, leadership, and individual and team performance [5]. This sentiment is reinforced in Committee Opinion Number 590 from The
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