Self-Assessment and Modulation of Applied Force During Shoulder Dystocia Simulation Training [ID: 1376207

Abstract

INTRODUCTION: Diagnosis of shoulder dystocia (SD) relies on clinicians' subjective assessment of the need to apply “more-than-usual” traction. We sought to determine whether providers' diagnostic traction (DT) for SD in a simulated setting is modifiable by force training. METHODS: As part of an IRB-approved study, we tethered a fetal mannequin with embedded force sensors to a simulated pelvis such that it would not deliver. We asked participants to apply their DT for SD, and then stop. We then asked them to apply their own estimate of 20 lb of traction, which is below the published 22-lb threshold for brachial plexus injury. Blinded from participants' view, we recorded the actual force applied at each attempt and asked each participant to estimate in pounds the DT they perceived to have applied. We then revealed actual force applied and allowed participants to practice with actual force measurements in view; this was followed by another blinded sequence of traction applications and estimations. Differences between actual and estimated DT pretraining and posttraining, were compared using t test, with significance at P less than .05. RESULTS: The mean DT among 103 participants decreased from 15.3 to 12.3 lb posttraining (P<.0001). Pretraining, participants underestimated their own applied traction by an average of 30% (9.3±5.2 versus 15.3±7.9 lb, P<.001); accuracy of self-assessment improved to 100% post-training (12.1±5.5 versus 12.3±5.0 lb, P=.66). CONCLUSION: With force training, accuracy of self-assessment of DT improves significantly; and applied force to diagnose SD decreases significantly below injury threshold.