Mode of delivery: Development and implementation of an obstetrical in situ simulation program

Abstract

Objectives Simulation is valued as a teaching and learning tool in obstetrics. In situ simulation assesses the hands-on and critical thinking skills of a team within their clinical setting. We aimed to create an in situ simulation program to promote skill acquisition, enhance team work and identify underlying system limitations. Methods Key obstetrical emergencies were identified through a needs assessment. In situ simulations were developed to address these clinical presentations. Latent safety threats were identified by organizers and participants. Medical management was evaluated through comprehensive emergency specific checklists. Leadership attitudes were assessed using the modified Perinatal Emergency Team Response Assessment tool. Following each simulation, team members were debriefed and qualitative and quantitative feedback was solicited and aggregated by specialty and discipline. Results Simulations were conducted monthly at two academic centers over 14 months. Multidisciplinary participation included medical learners, staff physicians, nursing, and allied health from Obstetrics, Anesthesia and Neonatology. Overall, participants reported their involvement was enjoyable. Participants reported improved communication skills, content knowledge and procedural knowledge. Participants rated the spontaneity of simulations, clinically relevant scenarios, safe learning environment and use of realistic equipment favourably. Latent safety threats were identified relating to equipment, medication, personnel, resources and technical skills. Conclusions We present the successful implementation of a comprehensive in situ simulation program in two busy academic centers. In situ simulation allows for deliberate practice of obstetrical emergencies and promotes a culture of patient safety and collaborative care. The lessons learned serve as valuable data to identify limitations within current practices and inform future policy change. Simulation is valued as a teaching and learning tool in obstetrics. In situ simulation assesses the hands-on and critical thinking skills of a team within their clinical setting. We aimed to create an in situ simulation program to promote skill acquisition, enhance team work and identify underlying system limitations. Key obstetrical emergencies were identified through a needs assessment. In situ simulations were developed to address these clinical presentations. Latent safety threats were identified by organizers and participants. Medical management was evaluated through comprehensive emergency specific checklists. Leadership attitudes were assessed using the modified Perinatal Emergency Team Response Assessment tool. Following each simulation, team members were debriefed and qualitative and quantitative feedback was solicited and aggregated by specialty and discipline. Simulations were conducted monthly at two academic centers over 14 months. Multidisciplinary participation included medical learners, staff physicians, nursing, and allied health from Obstetrics, Anesthesia and Neonatology. Overall, participants reported their involvement was enjoyable. Participants reported improved communication skills, content knowledge and procedural knowledge. Participants rated the spontaneity of simulations, clinically relevant scenarios, safe learning environment and use of realistic equipment favourably. Latent safety threats were identified relating to equipment, medication, personnel, resources and technical skills. We present the successful implementation of a comprehensive in situ simulation program in two busy academic centers. In situ simulation allows for deliberate practice of obstetrical emergencies and promotes a culture of patient safety and collaborative care. The lessons learned serve as valuable data to identify limitations within current practices and inform future policy change.