Management Of Shoulder Dystocia Research Articles

Virtual Reality Streaming for Remote Medical Training: Evaluation of Interface Usability with Physicians

A novel virtual reality (VR) system for streaming medical training was designed and evaluated from a user-centered perspective. We developed the VR user interface for remote medical training based on interviews with physicians who instruct medical simulation sessions. We then conducted usability tests with eleven board-certified physicians who specialize in Emergency Medicine or Obstetrics and Gynecology (OBGYN) Physicians used the novel VR system to watch stereoscopic video of a training simulation for an obstetrica emergency: management of shoulder dystocia. Physicians then rated the usability of the VR system. Th average usability rating was above an "A+" grade average on an industry benchmark scale.

Effects of high fidelity simulation model on midwives' shoulder dystocia management skills: An educational İntervention study.

Shoulder dystocia is an emergency and risky situation that most likely directly involves midwives. The aim of this study is to determine the effects of simulation training with a high fidelity mannequin on midwives' shoulder dystocia management. This study utilized a quantitative, quasi-experimental research design. No sample selection was made. The study included all midwives (n:16) working in the maternity unit of Manisa Province Hospital, Turkey. Management of shoulder dystocia was lectured both theoretically and practically, using a high fidelity simulation. Midwives' shoulder dystocia management skills and knowledge were evaluated before and after training using shoulder dystocia knowledge form and management skill checklist. There was a statistically significant increase in their shoulder dystocia management knowledge scores and management skills after simulation-based shoulder dystocia training (P < 0.05). Before the training, the midwives (62.5%) mostly used the McRoberts maneuver and suprapubic pressure as the primary interventions in shoulder dystocia management. After training, all the midwives were able to apply secondary maneuvers (Wood's or Rubin's maneuvres or posterior arm delivery) along with the primary maneuvers, in accordance with the shoulder dystocia management algorithm. Using a high fidelity simulation model in training increased midwives' shoulder dystocia management skills and knowledge.

Performing double episiotomy for shoulder dystocia management. Case report

Shoulder dystocia is an obstetric emergency that occurs in approximately 1% of vaginal deliveries. This situation is related with neonatal morbidity and mortality as long as maternal complications. The management of shoulder dystocia should be quick in order to avoid serious consequences. This case report is about the immediate diagnosis and successful management of shoulder dystocia through performing a second episiotomy after the HELPER mnemonic failed.

From tradition to Simulation: An experience of team training on management of shoulder dystocia.

To determine if simulation-based team training improves the management of shoulder dystocia compared to traditionally taught obstetrical emergencies. The prospective mixed-method study was conducted at the Centre for Innovation in Medical Education at the Aga Khan University, Karachi, from June to August 2018, and comprised doctors and nurses having up to five years of labour and delivery experience. The subjects were divided into two equal groups which were further subdivided into four equal teams. Group 1 was taught to manage shoulder dystocia using traditional lectures and hands-on pelvic models, while group 2 was trained in a simulated environment with a simulated scenario of shoulder dystocia. After two weeks, the performance of both teams were assessed and compared. Data was analysed using SPSS 19. A focus group discussion was subsequently conducted on the quality of the simulation experience. Of the 32 subjects, 16(50%) each were doctors and nurses. They were divided into groups having 16(50%) members each, and each group had 4 teams having 4(25%) subjects. The overall mean age of the sample was 31.9±2.8 years (range: 28-38 years). The mean score for performance on technical and communication task of group 2 was 10.25±1.258 compared to 5.7±2.500 in group 1 (p=0.028). Focus group participants agreed that training in a simulated environment was far superior than being traditionally taught. Simulation-based team training in shoulder dystocia management was associated with better feedback than traditional-style teaching.

Facilitating midwifery clinical skill development online: A case study

The 2020 Year of the Nurse and Midwife has presented many challenges following the World Health Organisation declaring a world pandemic due to COVID-19 on 11th March 2020. One of these challenges relates to the preparation of undergraduate nurses and midwives for a largely clinically based profession within a tertiary setting. Comprehensive educational preparation of midwives for registration and practice is at the core of quality midwifery care leading to optimisation of outcomes for women and their babies. To ensure graduate midwives are clinically competent, extensive professional placement is complimented by immersive simulation sessions focussing on; midwifery practice, skill, and clinical decision-making development in laboratory sessions. Due to social distancing restrictions imposed by the Australian Government all face-to-face sessions within a Queensland university were moved online between late March and July 2020. This presented opportunities to redesign teaching practices and implement innovations to continue to provide a high quality, award winning Bachelor of Midwifery Program. This paper will present a case study of an innovative strategy utilised within a Blackboard environment to facilitate skills development of two core critical midwifery skills, management of shoulder dystocia and estimation of postpartum blood loss.

Overview of techniques to manage shoulder dystocia during vaginal birth.

Shoulder dystocia is an obstetric emergency which is unpredictable and complicates approximately 0.5–1% of vaginal births. This article discusses the risk factors and the associated fetal and maternal complications, while it is also an overview of techniques and algorithms to handle shoulder dystocia.

536 Association of neonatal birthweight with shoulder dystocia management

To evaluate maneuvers associated with shoulder dystocia resolution in patients delivering neonates with a birthweight >4000g compared to <4000g This is a retrospective cohort of patients who delivered between September 2014 and August 2018 at a tertiary care center whose delivery was complicated by shoulder dystocia. The proportion of patients who underwent a maneuver beyond McRoberts was compared between patients who delivered neonates with birthweight >4000g vs <4000g. Secondary outcomes included total number of maneuvers, specific maneuvers performed, final maneuver prior to delivery, maternal trauma, dystocia length and neonatal morbidity. Continuous and categorical variables were evaluated using Wilcoxon rank sum and Fisher’s exact test. Relative risks were calculated with a confidence interval (CI) of 95% being considered significant. Of the 481 patients meeting study criteria, 9 were excluded due to lack of informative data. Patients with a neonate weighing >4000g (n=156, 33.0%), compared to those with a neonate weighing 35 (42.2% vs 30.1%) and less likely to undergo operative delivery (4.5% vs 10.8%). Patients with a neonate weighing >4000g were more likely to undergo a maneuver beyond McRoberts (RR 1.24, CI 1.08-1.42); and remained so after adjusting for BMI, diabetes and operative delivery (aRR 1.26, CI 1.06-1.41). Patients with a neonate weighing >4000g were more likely to have a 3rd/4th degree laceration (RR 2.62, CI 1.43-4.79), have a dystocia lasting >90 seconds (RR 1.63, CI 1.12-2.37) and had a higher mean total of maneuvers performed (2.2 vs 1.9 p=value 0.004). Neonates weighing >4000g were more likely to have brachial plexus injury (RR 5.1, CI 1.62-15.94) and clavicular fracture (RR 3.77, CI 1.54-9.27). Patients with neonates weighing >4000g, as compared to <4000g, are more likely to undergo a maneuver beyond McRoberts during shoulder dystocia. Further data is needed to evaluate if shoulder dystocia management should be guided by suspected fetal weight.

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

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.

Changing the Landscape of Obstetric Resident Education in LMIC Using Simulation Based Training [37G

INTRODUCTION: Maternal mortality continues to be one of the largest health burdens in reproductive-aged women in low- and middle-income countries (LMIC). Simulation-based training (SBT) has been previously piloted demonstrating that SBT was an accepted method of teaching skills for managing high-risk labor in LMIC. METHODS: An in-country simulation based education course on the management of post-partum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) were provided to three major governmental teaching hospitals in Guatemala City, Guatemala. Participants were 46 OB/GYN residents. A paired Student t-test was conducted to compare clinical knowledge regarding these obstetric emergencies at three timepoints: before SBT, one week, and six months after SBT. RESULTS: There was significant increase in scores in clinical knowledge of SD and MCA one week (M=7.83, SD=1.1) following SBT compared to baseline (M=5.96, SD=1.75); P≤.05. However, for PPH there was no increase in scores one-week (M=2.91, SD=0.94) following SBT compared to baseline (M=2.73, SD 0.65); P&gt;.05. Additionally, the difference in scores was maintained at six months following SBT for SD and MCA (M=7.52, SD=1.09) compared to baseline (M=5.96, SD=1.75); P≤.05. PPH scores at six-months (M=3.36, SD 0.65) showed a significant increase compared to baseline (M=2.73, SD=0.65); P≤.05. CONCLUSION: Simulation-based training was found to be an effective method to increase cognitive clinical knowledge in LMIC for rarely seen events of MCA and SD but not with the more common event of PPH. This knowledge increase was maintained six-months after participation in the training.

THE ROLE OF SIMULATION BASED EDUCATION IN A MORE EFFECTİVE EMERGENCY OBSTETRIC HEALTH SERVICES

Günümüzde teknolojide yaşanan gelişmelerin öncülüğünde sağlık personellerinin alanlarında daha etkin olabilmesi için yeni öğrenme metotları geliştirilmektedir. Bu metotlardan biri de simülasyon uygulamasıdır. Simülasyon uygulaması, kişinin deneyim kazanmasını sağlayarak karşılaşacağı olası bir durumda profesyonel bir şekilde vakaya müdahale etmesini sağlayan bir uygulamadır. Acil obstetrik sağlık hizmeti; doğum ve postpartum dönemde meydana gelen, anne ve bebek hayatını tehdit eden, acil müdahale gerektiren durumlarda verilen hizmetlerdir. Bu hizmetlerin hızlı ve nitelikli müdahale ile anne ve bebek sağlığını koruyarak verilebilmesi için simülasyonun obstetride yaygın kullanılması önemli bir unsurdur. Simülasyon eğitimi, multidisipliner bir yaklaşımla obstetrik acil vakalara etkili müdahale becerisini artırarak bu konudaki bilgi düzeyini geliştirir. Gerçek vakaları riske atmadan güvenli bir ortamda bireysel becerileri, bilgi ve tutum ile bütünleştirerek uygulamaları öğrenme ve tekrar etme olanağı sağlar. Böylece, klinik karar verme, öz-yeterlilik, kliniksel iletişim becerileri ile kendine güven düzeyinde iyileşmeye ve anksiyete düzeyinde ise azalmaya olanak sağlanır. Ayrıca, simülasyon eğitimi ile obstetrik bir komplikasyonda olayın etyopatogenezi ve yönetimde kullanılan tekniklerin etkinliği de araştırılır. Günümüzde simülasyon eğitimi; servikal dilatasyonun değerlendirilmesi, amniosentez, doğum, makat doğum ve omuz distosisinin yönetimi, umbilikal kord prolapsusu, sezaryen, eklampsi, postpartum kanama, maternal kardiyak arrest gibi acil obstetrik durumların yönetiminde yaygın olarak kullanılmaktadır. Bu derlemenin amacı ilgili literatür incelenerek, acil obstetrik sağlık hizmetlerinin daha etkin verilmesinde simülasyona dayalı eğitimin rolünü ortaya koymaktır.

Maneuvering Through a Birth Complicated by Shoulder Dystocia

Shoulder dystocia is an unpredictable intrapartum emergency with potentially devastating consequences. In this article, the etiology, pathophysiology, and clinical management of shoulder dystocia are reviewed; institutional readiness and potential legal implications are discussed. Also considered are posttraumatic stress disorder and secondary traumatic stress, adverse psychological consequences that may be experienced by women, midwives, and other intrapartum care providers, including staff.

Persistence and Extent of Neonatal Brachial Plexus Palsy: Association with Number of Maneuvers and Duration of Shoulder Dystocia

Objective The main objective of this article is to determine if persistence of neonatal brachial plexus palsy (NBPP) following shoulder dystocia was associated with maneuvers used or duration of impacted shoulder. Study Design Retrospective review of children with NBPP and documented shoulder dystocia. Student t -tests and chi-squared tests were used to compare outcomes when shoulder dystocia resolved with > 3 versus ≤ 3 maneuvers or duration > versus ≤ 120 seconds. Relative risk (RR) with 95% confidence intervals (CI) was calculated. Results Among 46 children with NBPP and shoulder dystocia, incidence of persistence was significantly higher at 2 years of age when > 3 versus ≤ 3 maneuvers were used (100 vs. 62%; RR: 1.6, 95% CI: 1.2–2.2). When resolution of impacted shoulder lasted >120 versus ≤ 120 seconds, NBPP at 2 years was significantly more likely (100 vs. 63%; RR: 1.6, 95% CI: 1.1–2.2). Injury to all five nerves of the brachial plexus was more likely if standard deviation lasted > 120 versus ≤ 120 seconds (RR: 2.2; 95% CI: 1.03–4.6). Conclusion Though the number of maneuvers used and duration of shoulder dystocia are associated with persistence of NBPP, the retrospective nature of the study of a selective cohort precludes recommendations changing the current management of shoulder dystocia.

435: Interest of a checklist in the management of shoulder dystocia

435: Interest of a checklist in the management of shoulder dystocia

299: Association of maternal body mass index with shoulder dystocia management

To evaluate maneuvers associated with shoulder dystocia resolution in women with a body mass index (BMI) >35 kg/m2 compared to those with BMI < 35 kg/m2. This is a retrospective cohort of women who delivered between September 2014 and August 2018 at a tertiary care center and whose delivery was complicated by shoulder dystocia. The proportion of patients who underwent a maneuver beyond McRoberts and suprapubic pressure was compared between women with admission BMI >35 vs < 35 kg/m2. Secondary outcomes included total number of maneuvers, specific maneuvers performed, final maneuver prior to delivery, maternal pelvic trauma and length of dystocia. Continuous and categorical variables were evaluated using Wilcoxon rank sum and Fisher’s exact test. Relative risks were calculated with a confidence interval (CI) of 95% being considered significant. Of the 481 women meeting study criteria, 12 were excluded due to lack of informative data. Women with a BMI >35 (n=159, 33.9%), when compared to those with a BMI < 35 (n=310, 66.1%), were more likely to have gestational diabetes treated with medication (RR 2.5, CI 1.29-4.73). Other demographic factors were similar. Women with a BMI >35 were more likely to undergo a maneuver beyond McRoberts and suprapubic pressure (RR 1.19, CI 1.03-1.37), episiotomy (RR 1.87, CI 1.12-3.14) and attempted delivery of the posterior arm (RR 1.46, CI 1.19-1.80). They also had a higher mean total of maneuvers performed (2.2 vs 1.9 p=value 0.007) and posterior arm delivery was more likely to be the final maneuver prior to delivery (RR 1.66, CI 1.23-2.25). Length of dystocia and maternal pelvic trauma were similar regardless of BMI. BMI >35, compared to a BMI < 35, is associated with performance of a maneuver beyond McRoberts and suprapubic pressure as well as episiotomy during shoulder dystocia. Delivery of the posterior arm is also more often the final maneuver prior to delivery in this group. Further data is needed to evaluate if shoulder dystocia management should be individualized for maternal BMI.

A Nationwide Needs Assessment to Identify and Prioritize Technical Procedures for Simulation in Obstetrics and Gynaecology: A Delphi Study.

The aims of the study were to identify and prioritize technical procedures that should be developed and integrated in a simulation-based curriculum for obstetrics and gynaecology residents. The Delphi method was used, consisting of three rounds of survey questionnaires. Key leaders across Denmark were invited to participate. In Delphi round 1, the participants individually identified technical procedures that newly authorized specialists should be able to perform. These procedures were sent to round 2 to be explored for need for simulation-based training by estimating frequency of procedures, number of doctors, potential patient risk and/or discomfort, and feasibility of simulation. Round 3 consisted of elimination and prioritization of remaining procedures (Canadian Task Force Classification III). A total of 165 key leaders were invited. Response rates were 61%, 50%, and 53%, respectively. Identified procedures in Round 1 were as follows: gynaecology (n = 51), obstetrics (n = 40), and general procedures (n = 10). A needs assessment formula was used to calculate needs for training on the basis of the answers in round 2 and produce a preliminary prioritized list that was sent to round 3 for final exploration. Round 3 consisted of elimination and final prioritization, where gynaecology (n = 17) prioritized basic laparoscopy, vaginal ultrasound, and laparoscopy with salpingostomy and salpingectomy; obstetrics procedures (n = 16) prioritized basic resuscitation of newborn, vacuum extraction, and management of shoulder dystocia; and one general procedure (basic adult resuscitation) was included. A needs assessment using the Delphi method produced a prioritized list of technical procedures suitable for simulation. This can guide the development of simulation-based training programs.

Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents.

IntroductionNewborn delivery and resuscitation are rare, but essential, emergency medicine (EM) skills. We evaluated the effect of simulation on EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.MethodsWe developed a novel simulation that integrates a shoulder dystocia with neonatal resuscitation and studied a convenience sample of EM residents. Each 15-minute simulation was run with one learner, a simulated nurse, and a standardized patient in situ in the emergency department. The learner was required to reduce a shoulder dystocia and then perform neonatal resuscitation. We debriefed with plus/delta format, standardized teaching points, and individualized feedback. We assessed knowledge with a nine-question multiple choice test, confidence with five-point Likert scales, and clinical performance using a checklist of critical actions. Residents repeated all measures one year after the simulation.ResultsA total of 23 residents completed all measures. At one-year post-intervention, residents scored 15% higher on the knowledge test. All residents increased confidence in managing shoulder dystocia on a five-point Likert scale (1.4 vs 2.8) and 80% increased confidence in performing neonatal resuscitation (1.8 vs 3.0). Mean scores on the checklist of critical actions improved by 19% for shoulder dystocia and by 27% for neonatal resuscitation.ConclusionImplementing simulation may improve EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.

Improving Shoulder Dystocia Outcomes With Teamwork and Deliberate Practice [26S

INTRODUCTION: The management of shoulder dystocia requires coordinated time-sensitive teamwork. A complication of performing the posterior arm delivery is neonatal humerus fracture. The study objective was to determine the effectiveness of teaching shoulder dystocia management using simulation aimed at teamwork and communication, with a focus on deliberate practice of posterior arm delivery skills. METHODS: A prospective pre/post educational study design was used to assess effectiveness of a curriculum designed for labor and delivery personnel using simulation for the coordinated team management of shoulder dystocia. A portable task trainer was used to practice safe delivery of the posterior arm including inserting the provider hand on the side of the fetal chest and splinting of the humerus. Outcomes were measured using performance assessment scores, safety culture surveys and the rate of neonatal humerus fractures in shoulder dystocias over one year. Internal review board exemption was obtained. Paired t-tests and repeated measures were used for data analysis. RESULTS: Teamwork drills were held with 166 multi-disciplinary participants in a large obstetrical hospital over one year. Statistically significant improvement occurred in knowledge (pre 64.01%, post 94.22%, p&lt;0.0001), performance (pre 61.83%, post 92.86%, p&lt;0.0001) and safety culture surveys (pre 3.27, post 1.57, p&lt;0.0001, 1=high, 5=low). Compared with the year prior to the study, the rate of neonatal humerus fractures in shoulder dystocias was reduced by 42.86%, (pre 5.51%, post 3.88%, p&lt;0.0001). CONCLUSION: Simulation training improved teamwork performance during shoulder dystocia emergencies. Deliberate practice of posterior arm delivery skills significantly reduced the rate of neonatal humerus fractures.

Are OB/GYN Residents Receiving Adequate Training for Shoulder Dystocia? [29J

INTRODUCTION: Data are lacking to determine whether residents are competent to manage shoulder dystocia, as the ACGME does not track this condition. We sought to ascertain whether OB/GYN residents felt that they had received adequate training to independently handle shoulder dystocia. METHODS: A 25-question web-based survey was electronically disseminated to program directors of all accredited US OB/GYN residency programs. The survey was sent four times on a weekly basis. A Likert scale was used to query the residents with regards to clinical and didactic training experience. Survey monkey and IBM SPSS Statistics were used to analyze the responses. RESULTS: Nearly all (97%) of the 116 residents who responded had received formal lecture training and underwent simulation drills (87%), and most (89%) felt that they had received appropriate didactic training. 64% of residents had participated in < 10 total cases of shoulder dystocia. Only 51.7% and 48.3% agreed that they could currently independently perform delivery of the posterior fetal arm and fetal rotational maneuvers, respectively. Approximately half of residents (47%) responded that they had never independently managed a shoulder dystocia from start to finish. Slightly more than one third of residents strongly agreed that after completion of residency training they would feel comfortable independently managing a shoulder dystocia. CONCLUSION: Residency programs have incorporated simulation and didactic lectures into shoulder dystocia teaching. This does not appear to have translated into clinical competence in handling this obstetrical emergency.

Introduction of Posterior Axilla Sling Traction in Simulated Shoulder Dystocia.

Objective Aim of this study was to introduce posterior axilla sling traction (PAST) in delivering providers and nursing staff as an adjunct to the management of shoulder dystocia and evaluate comfort in performing the maneuver. Methods A presimulation questionnaire had given to all participants. A brief training on how to perform PAST was also given. A simulated shoulder dystocia was run where usual maneuvers failed. Participants used PAST for delivery of posterior shoulder, delivery of posterior arm, and to assist with rotation. Participants were then given a post-simulation questionnaire. A Chi-squared test was used to evaluate comfort with performing the procedure pre and post-simulation. Results Data were collected from 43 participants at pre and post-simulation. Designations (attending, resident, midwife, registered nurse) and responses were recorded to the questionnaires. There was a statistically significant increase in the number of providers and nurses who would feel comfortable using PAST for shoulder dystocia management and for rotational maneuvers. Ninety-three percent of participants would consider using PAST in future shoulder dystocia when usual maneuvers failed. Conclusion PAST is an adjunct to management of shoulder dystocia that has not previously been taught in our facility. The majority of participants in our simulation felt comfortable with using PAST.

Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis.

Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.