Obstetric Simulation Research Articles

Optimization of Obstetric and Neonatal Simulations

Team collaboration is essential in obstetric and neonatal medicine, with the interprofessional group forming the basis of any labor and birth in the postpartum and neonatal environment. The management of emergencies requires not only technical skills but also communication, leadership, and the ability to maintain situational awareness. Simulation had become a useful tool for team training, having been shown to improve and strengthen teamwork. An opportunity to increase patient safety, by improving communication among teams from different clinical units, was recognized after TeamSTEPPS training. A women’s health division-wide simulation program (WHDSP) was designed to promote a collaborative relationship among the interprofessional team and to optimize team performance and patient safety. Develop and implement a WHDSP that encompasses team responses throughout the continuum of care, from intrapartum to the postpartum period. An interprofessional team convened to discuss strategies to improve communications across clinical units. We partnered with the organization’s simulation center and created clinical scenarios that followed various points of care for the woman and her newborn. In situ simulations using a standardized patient were created to mirror “real life” emergencies. Each simulation was debriefed, and staff offered feedback on the emotional and tangible support they received throughout the exercise. A team debriefing was guided by an experienced simulation instructor. The goal of the debriefing was to allow team members to actively reflect on their own and the team’s performance. Each simulation was video recorded and analyzed. The observation summary conveyed outcome measures on the process, infrastructure, and collaboration benchmarks. Improvement in the use of closed-loop communication as well as handoffs between units and strengthened teamwork collaboration have been established. Since the implementation of TeamSTEPPS, the percentage of harm events reaching a patient has decreased from 12% of all events preintervention to a low of 3% of all events postintervention. Communication and interprofessional collaboration are crucial in providing safe patient care. The development of this program helped identify gaps in communication and teamwork throughout the division. Resolving conflicts during transitions in care, improving information sharing, and eliminating barriers to quality and safety are our ultimate goals.

Analiza cech symulatorów wysokiej wierności w dziedzinie położnictwa

Analiza cech symulatorów wysokiej wierności w dziedzinie położnictwa

Lessons learnt from an obstetric and neonatal emergency simulation program in India

BackgroundCombined obstetric and neonatal emergency simulation based training is gaining popularity in healthcare settings. Methods: In this qualitative study, through semi-structured one to one interviews, we evaluated participant attitudes, perceptions of retention of learning, and application to clinical practice one year after a simulation workshop. Audio recordings of interviews were transcribed, collated and subjected to thematic analysis. Results: Five major themes were identified through the thematic analysis: comparing simulation to clinical practice; learning and working in teams; thinking retention and sustainability; relating relevance of simulation based education to roles; and managing leadership. Conclusions: Participants’ acknowledgement of training being relevant to their routine practice, and keenness to learn management of complicated births highlighted the sustained impact of obstetric and neonatal emergency simulation training.

Obstetric simulation for a pandemic

ObjectiveIn the middle of the COVID-19 pandemic, guidelines and recommendations are rapidly evolving. Providers strive to provide safe high-quality care for their patients in the already high-risk specialty of Obstetrics while also considering the risk that this virus adds to their patients and themselves. From other pandemics, evidence exists that simulation is the most effective way to prepare teams, build understanding and confidence, and increase patient and provider safety. FindingPracticing in-situ multidisciplinary simulations in the hospital setting has illustrated key opportunities for improvement that should be considered when caring for a patient with possible COVID-19. ConclusionIn the current COVID-19 pandemic, simulating obstetrical patient care from presentation to the hospital triage through postpartum care can prepare teams for even the most complicated patients while increasing their ability to protect themselves and their patients.

Impact of Physician Expertise on Probe Trajectory During Obstetric Ultrasound: A Quantitative Approach for Skill Assessment.

The objective of the study was to identify objective metrics to evaluate the significance of a sonographer's expertise on trajectories of ultrasound probe during obstetric ultrasound training procedures. This prospective observational study was conducted at Rennes University Hospital, Department of Obstetrics and Gynecology. We evaluated a panel of sonographers (expert, intermediate, and novice) in performing 3 tasks (brain, heart, and spine) with an obstetric ultrasound simulator (Scantrainer; Medaphor, Cardiff, UK). The trajectories of the probe were logged and recorded by a custom data acquisition software. We computed metrics on the trajectories (duration, path length, average velocity, average acceleration, jerk, working volume) to compare the 3 groups and identify discriminating metrics. A total of 33 participants were enrolled: 5 experts, 12 intermediates, and 16 novices. Discriminatory metrics were observed among the 3 levels of expertise for duration, velocity, acceleration, and jerk for brain and spine tasks. Working volume was discriminatory for the brain and the heart task. Path length was discriminatory for the brain task. Our results suggest a relationship between the sonographer's level of expertise and probe trajectory metrics. Such measurements could be used as an indicator of sonographer proficiency and contribute to automatic analysis of probe trajectory to evaluate the quality of sonography and the sonographer.

The Impacts of Obstetrical Simulation Training for Emergency Medical Service Providers [40G

INTRODUCTION: Obstetrical emergencies in the field require coordinated time-sensitive teamwork between emergency medical services (EMS) and hospital-based teams. Simulation is effective at preparation for emergencies. The study objective was to determine the educational and clinical impacts of simulation training sessions for emergency medical service personnel by obstetrical teams within the same communities. METHODS: A multi-center prospective pre/post educational study design was used to assess the effectiveness of a curriculum designed for emergency medical service providers on obstetrical emergencies. Instructional strategies included team-based checklist review and skills coaching using low-fidelity task trainers, taught by interdisciplinary teams. Outcomes were measured using pre/post educational tests, team performance assessments, course evaluations and clinical impacts. Internal review board exemption was obtained. Paired t-tests were used for data analysis. RESULTS: Over 18 months, 185 EMS personnel participated in the curriculum taught at 2 community hospitals. Instructors included obstetricians, emergency physicians, nurses, and medical students. Significant improvement in knowledge was achieved (pre 47.8%, post 89.6%, P<.0001). Confidence (1=high, 5=low) improved in managing precipitous delivery (pre 3.77, post 1.52, P<.0001), shoulder dystocia (pre 4.0, post 1.48, P<.0001), eclampsia (pre 2.68, post 1.29, P<.0001), breech (pre 4.68, post 2.21, P<.0001), and PPH (pre 3.68, post 1.33, P<.0001). Team performance assessments demonstrated significant improvement (pre 68.54%, post 93.54%, P<.0001). Qualitative clinical impacts included improvements to EMS protocols, transfer of care and communication between teams. CONCLUSION: Simulation training in obstetrical emergencies for emergency medical service providers improves knowledge, skills, and performance. Instruction by obstetrical teams in the same communities enhances communication and collaborative care.

Sticky models

This paper explores the material histories which influence contemporary medical education. Using two obstetric simulators found in the distinct teaching environments of the University of Development Studies in the north of Ghana and Maastricht University in the south of the Netherlands, this paper deconstructs the material conditions which shape current practice in order to emphasise the past practices that remain relevant, yet often invisible, in modern medicine. Building on conceptual ideas drawn from STS and the productive tensions which emerge from close collaboration between historians and anthropologists, we argue that the pull of past practice can be understood as a form of friction, where historical practices ‘stick’ to modern materialities. We argue that the labour required for the translation of material conditions across both time and space is expressly relevant for the ongoing use and future development of medical technologies.

Emergency surgical obstetrics simulation training: an ex vivo low-cost model using bovine uterus and porcine bladder for haemostatic uterine brace suture techniques

Postpartum haemorrhage remains a leading cause of maternal mortality and morbidity. While conventional obstetrics training curricula describe at length the management of postpartum haemorrhage, obstetrics trainees rarely have exposure to...

The German interprofessional attitudes scale: translation, cultural adaptation, and validation.

Objectives: The implementation of obstetric hybrid simulation and interprofessional collaboration between midwives and anesthetists in labor emergencies fostered the need to evaluate the impact of such a program. The original Interprofessional Attitude Scale (IPAS) assesses interprofessional attitudes among health professional students and includes the 2011 and 2016 Interprofessional Collaborative Practice report competency domains. The purpose of this study was to create a German version of the IPAS (G-IPAS) to use for the education of healthcare students. Methods: We performed the translation and validation of the IPAS in five steps: translation to German according to the International Society of Pharmaeconomics and Outcome Research guidelines; nine cognitive interviews with healthcare professionals and students;calculation of the Content Validity Index (CVI) by expert opinion; exploratory factor analysis (EFA); and internal consistency by Cronbach’s alpha. All study participants gave written informed consent and the cantonal ethics committee waived further ethical approval.Results: The cognitive interviews led to replacement of single-item wording. We retained 27 items for CVI analysis. The averaged overall CVI was 0.79, with 15 items ≥0.89. 185 students (70 medicine, 51 nursing, 48 physiotherapy, and 16 midwifery) contributed with data for the EFA and it produced three subscales. “Teamwork, roles, and responsibilities” with factor loadings ≥0.49, “Patient-centeredness” with factor loadings ≥0.31, and “Community-centeredness” with factor loadings ≥0.57. Two items of the total scale were deleted, and four items were redistributed to another subscale. Cronbach’s alpha for the overall G-IPAS scale was 0.87. After deleting and redistributing items in subscales, a new Scale-CVI/Average was calculated and was 0.82.Conclusions: Based on a rigorous validation process, the G-IPAS provides a reliable tool to assess attitudes towards interprofessional education among different healthcare professions in German-speaking countries.

The state of emergency medical technician education in Ghana.

ObjectiveThe National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students.MethodsA standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings.ResultsStudents and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25).ConclusionThe faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.

Effect of implementing simulation obstetric triage training on nurses' knowledge and practices

Background: Obstetric triage is a screening platform for evaluation of maternal and fetal conditions primarily. However, in many settings, it used to manage pregnancy complications as well as emergent obstetric conditions Aim: This study aimed to investigate the effect of implementing simulation obstetric triage training on nurses' knowledge and practices. Design: A quasi-experimental pre/ post-test design (one group) was used to conduct this study. Setting: The present study was conducted at labor and delivery emergency unit in the Mansoura University Hospital, General Hospital and Health Insurance Hospital, Mansoura, Egypt. Sample: A convenient sample of seventy nurses who worked at pervious mentioned setting from first of July to the end of October 2019. Tools: Data were collected through three tools I: Self-Administered Structured Schedule to assess general characteristics of the nurses and nurses’ knowledge regarding obstetric triage. II: Observational check list to observe nurses’ practices during implementation of obstetric triage. III: Nurses’ satisfaction with the simulation obstetric triage training Results: There were improvement in the obstetric nurses’ knowledge regarding obstetric triage from (14.3%) pre implementation of the simulation training to(81.4%) post implementation. Also, there were improvement in the obstetric nurses’ practices regarding obstetric triage from (2.9 %) pre-implementation to (91.4%) post-implementation with highly statistically significant differences. Conclusion: The study hypotheses were accepted. There were highly statistically significant improvement in the nurses’ knowledge and practices scores post implementation of the simulation obstetric triage training than before. Indicating that obstetric simulation training was an effective tool for improving obstetric nurses’ knowledge and practices regarding obstetric triage. Recommendation: Periodical conducting of training programs regarding obstetric triage for obstetric nurses in labor and delivery emergency unit.

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries.

Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n=56) and post-training (2007-2011, n=80) groups. Case note review was undertaken to gather information. Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P=0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.

Obstetric simulation in undergraduate nursing education: An integrative review.

Simulation as an innovative teaching method is an effective form of pedagogical approach. A wealth of evidence shows that simulation in nursing education provides an opportunity for undergraduate students to improve learning outcomes. The aim of this review was to systematically appraise and synthesize evidence that examine the effects of obstetric simulation in an undergraduate nursing program. Integrative review method guided this review. Four electronic databases were searched using "CINAHL (EBSCOhost)," "Science Direct," "OVID," and "WILEY" to identify original research published between 2008 and 2018. Search and MeSH terms included: obstetric, maternal, simulation, nursing, and student. Seventeen articles were included in this review. The results of content analysis revealed three essential themes: cognitive and psychomotor (knowledge-skills) skill, affective (self-confidence, anxiety, critical thinking-self-efficacy) skill, and students' views on obstetric simulation. In all of the studies, it was determined that the simulation method was a safe and effective teaching strategy. The use of obstetric simulation in an undergraduate nursing program has a positive effect on the level of self-confidence, anxiety, critical thinking-self-efficacy, psychomotor skills, and level of anxiety.

Ochsner Obstetrics and Gynecology Simulation Program: A Review of the Literature and Description of a Multidisciplinary Simulation Program Targeting Management of Obstetric Emergencies.

Background: Simulation training improves the response to obstetric emergencies.Methods: We review the current literature regarding simulation training for provider education, team training, and obstetric outcomes and describe the implementation of a multidisciplinary obstetric simulation program.Results: A review of literature available at PubMed reveals many studies focused on provider education but few studies detailing the direct impact on patients. We review simulation reports that demonstrate improved clinical outcomes after obstetric emergencies—such as shoulder dystocia, postpartum hemorrhage, delivery of the second twin, operative vaginal delivery, urgent cesarean delivery, and neonatal resuscitation—as these studies formed the basis of the Ochsner Obstetrics and Gynecology Simulation Program in New Orleans, LA. We discuss the 3 principal simulation formats at Ochsner: a half-day course at the simulation training center, in-situ simulation on clinical care floors, and just-in-time training in the classroom. We also present detailed examples of simulation scenarios to assist others in creating a robust simulation program to ensure staff and providers are well trained to respond to obstetric emergencies.Conclusion: The Ochsner Obstetrics and Gynecology Simulation Program was formulated on published literature and incorporates a variety of clinical settings, scenarios, and approaches to improve educational opportunities and response to obstetric emergencies.

The role of medical simulation in obstetrics

Medical simulation is widely recognized as a didactic learning tool for students and health care professionals, with the aim to promote and implement measures dedicated to patient’s safety. It is growing rapidly worldwide, becoming part of the curricula in medical schools and medical societies. It represents a useful method of training for rare and complex situations, with catastrophic potential, for which health care professionals have no experience, could not learn it individually and which could overcome them cognitively. Obstetrics is the only specialty in which relevant results on clinical outcome have been demonstrated in the area of great obstetric emergencies. Medical simulation will increase the level of technical competence and communication, will promote an ethical and responsible behavior and a multidisciplinary teamwork. Its end result will be the improvement of patients’ safety.

428: Teamwork allows you to blame someone else: A Prospective study of neuroticism impacting obstetric simulation

428: Teamwork allows you to blame someone else: A Prospective study of neuroticism impacting obstetric simulation

Obstetric Decision-Making and Simulation

Obstetric Decision-Making and Simulation

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.

ACOG Simulation Working Group: A Needs Assessment of Simulation Training in OB/GYN Residencies and Recommendations for Future Research

To evaluate current availability and needs of simulation training among obstetrics/gynecology (OB/GYN) residency programs. Cross-sectional survey. Accreditation Council for Graduate Medical Education accredited OB/GYN residency programs in the United States. Residency program directors, gynecology simulation faculty, obstetrics simulation faculty, and fourth-year residents. Of 673 invited participants, 251 (37.3%) completed the survey. Among the survey responses, OB procedures were more broadly represented compared to the GYN procedures for simulation teaching: 8 (50%) of 16 OB procedures versus 4 (18.2%) of 22 GYN procedures had simulation teaching. Among the simulated procedures, a majority of residents and faculty reported that simulation teaching was available for operative vaginal delivery, postpartum hemorrhage, shoulder dystocia, perineal laceration repair, conventional laparoscopic procedures, and robotic surgery. There were significant differences between residents and faculty perceptions regarding the availability and needs of simulated procedures with a minority of residents having knowledge of Council on Resident Education in Obstetrics and Gynecology (47.2%) and American College of Obstetrics and Gynecology (27.8%) simulation tools compared to the majority of faculty (84.7% and 72.1%, respectively). More than 80% of trainees and faculty reported they felt the average graduating resident could perform vaginal, laparoscopic, and abdominal hysterectomies independently. Simulation is now widely available for both gynecologic and obstetric procedures, but there remains tremendous heterogeneity between programs and the perceptions of residents, program directors, and faculty. The variations in simulation training and readiness for performing different procedures following residency support the need for objective, validated assessments of actual performance to better guide resident learning and faculty teaching efforts.

E-learning et simulation en échographie focalisée pour la formation continue des sages-femmes en salle de naissance

ObjectiveTo evaluate a training program in limited obstetric ultrasound, combining e-learning and simulation. MethodsThis a descriptive cohort study in Single-center study conducted in a French university hospital. Thirty-three practicing midwives who had not received basic training in ultrasonography had unlimited access to an e-learning platform offering interactive theoretical instruction modules. Then, they attended a one-day simulator-based obstetric ultrasound workshop. A theoretical competency test was taken before the e-learning component (T1), then before (T2) and after (T3) the simulation workshop. Their competency in specific practical tasks was assessed before and after the workshop. A learner satisfaction questionnaire was completed after the program. ResultsThe mean score obtained in the theoretical competency test was 46.6% (range 8.3–83.3%) at T1, 87.2% (66.6–100%) at time T2, and 91.6% (66.6–100%) at T3. Significant improvements were observed between times T1 and T2 (P<0.001) or T3 (P<0.001), as well as in the performance of certain practical tasks, such as placental location (P=0.02) and visualization of the cervix (P=0.03). The mean number of logins to the e-learning platform during the program was 11.2 per participant (6–24). Most participants were satisfied with the training and reported an improvement in their daily practice. ConclusionTraining in limited obstetric ultrasound, combining e-learning to acquire theoretical knowledge and a hands-on simulation workshop, appears to meet the needs of practicing midwives. Most participants were satisfied with the proposed teaching and the rapid acquisition of ultrasound skills applicable to their clinical practice.