Emergency Obstetric Training Research Articles

Curriculum Development for the South African Essential Steps in Managing Obstetric Emergencies (ESMOE) Anesthesiology Training Module: A Delphi Study.

The United Nations Sustainable Development Goal 3 (SDG3) for 2030 aims at <70 maternal deaths per 100,000 live births. South Africa (SA) falls short of this goal and most deaths occur in district and regional hospitals. Due to low anesthesiologist (specialist anesthetist) numbers in the public sector, the anesthetic workforce in these hospitals consists mainly of nonspecialist (general practitioner) junior doctors with limited supervision. The Essential Steps in Managing Obstetric Emergencies (ESMOE) training program for interns was introduced in 2008 to reduce maternal deaths in SA. Training is not consistently offered at all intern-training institutions and it has not been recently revised. This study sought expert suggestions to guide a revision of the regulation, pedagogy, and content of the ESMOE anesthetic module. A 3-round consensus-seeking modified Delphi technique was used whereby experts rated current and suggested learning outcomes as well as pedagogical- and regulatory aspects of the ESMOE anesthetic module in an anonymous, online, Likert-scale questionnaire. Consensus was defined as ≥70% agreement. Open-ended questions sought motivations for decisions and further suggestions for program improvement. Between March 4, 2021 and August 18, 2021, a total of 17/24 (71%), 16/17 (94%), and 15/16 (94%) consenting experts completed the first, second, and third rounds, respectively. During the 3 rounds, the panel achieved consensus on all but 2 questionnaire items. The panel agreed that ESMOE anesthesia training should be mandatory and that it should be offered through a blended learning model. They further concurred that the current learning outcomes should be retained, and suggested additional outcomes based on the most common causes of maternal mortality in SA. Attendance of the ESMOE anesthesia module should be mandatory. Its pedagogy should be updated to a blended learning style to benefit the current digital native intern generation. The content should be updated to address the main causes of maternal mortality in SA in line with SDG3. A national obstetric anesthesia guideline should be considered, and lea-dership and collaboration are required to improve the alignment of undergraduate, internship, and junior doctor anesthesia training in SA. The content, process, and stakeholder engagement suggestions in this study can assist short-course-based anesthesia workforce training in similar global contexts.

The Impact of the Advances in Labour and Risk Management (ALARM) Course on Learners’ Perceptions of their Own and Others’ Professions

Background: Simulation-based training in emergencies is beneficial for all professionals who work in obstetrics. However, managing obstetric emergencies requires both technical and non-technical skills such as teamwork. Interprofessional education (IPE) offers an effective strategy for learning competencies in collaboration and teamwork. The Advances in Labour and Risk Management (ALARM) course offers a platform for simulated training in obstetric emergencies and has been offered for learners in maternity care at our university for the past five years. Objective: The aim of the project was to explore the impact of interprofessional learning during the ALARM course on the attitudes and perceptions of learners in maternity care. Methods: A two-part questionnaire was administered to midwifery students and to family medicine and obstetric residents before and after the ALARM course. The questionnaire incorporated the Interdisciplinary Educational Perception Scale (IEPS) and open-ended qualitative responses. Results: Despite openness to and awareness of the importance of collaboration for patient care demonstrated in the qualitative analysis, there was a statistically significant difference between learners’ pre- and post-ALARM IEPS scores, indicating more negative perceptions of IPE following the intervention. Conclusion: Learners in maternity care are aware of the need for collaboration in practice. More explicit attention to teamwork and collaboration as a component of the ALARM course would promote development of both technical skills and nontechnical collaborative competencies. This article has been peer reviewed.

Rural and regional maternity managers’ and educators’ views of the Maternity and Newborn Emergencies (MANE) education program in Victoria, Australia: a qualitative descriptive study

BackgroundAustralia has one of the lowest perinatal morbidity and mortality rates in the world, however a cluster of perinatal deaths at a regional health service in the state of Victoria in 2015 led to state-wide reforms, including the introduction of the Maternity and Newborn Emergencies (MANE) program. MANE was a 2-day interprofessional maternity education program delivered by external expert facilitators to rural and regional Victorian maternity service providers. An independent evaluation found that the MANE program improved the confidence and knowledge of clinicians in managing obstetric emergencies and resulted in changes to clinical practice. While there is a large volume of evidence that supports the use of interprofessional education in improving clinicians’ clinical practice, the impact of these programs on the overall safety culture of a health service has been less studied. Managers and educators have an important role in promoting the safety culture and clinical governance of the heath service. The aim of this study, therefore, was to explore Victorian rural and regional maternity managers’ and educators’ views and experiences of the MANE program.MethodsMaternity managers and educators from the 17 regional and rural health services across Victoria that received the MANE program during 2018 and 2019 were invited to participate. Semi-structured interviews using mostly open-ended questions (and with a small number of fixed response questions) were undertaken. Qualitative data were transcribed verbatim and analysed thematically. Descriptive statistics were used for quantitative data.ResultsTwenty-one maternity managers and educators from the 17 health services participated in the interviews. Overall, participants viewed the MANE program positively. Four themes were identified: the value of external facilitation in providing obstetric emergency training; improved awareness and understanding of clinical governance; improved clinical practice; and the importance of maintaining the program. Participants agreed that MANE had improved the confidence (94%) and skills (94%) of clinicians in managing obstetric emergencies, as well as confidence to escalate concerns (94%), and most agreed that it had improved clinical practice (70%) and teamwork among attendees (82%).ConclusionMaternity managers and educators were positive about MANE; they considered that it contributed to improving factors that impact the safety culture of health services, with delivery by external experts considered to be particularly important. Given the crucial role of maternity managers and educators on safety culture in health services, as well in program facilitation, these findings are important for future planning of maternity education programs across the state.Trial registrationTrial registration was not required for this study.

Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

(Acta Obstet Gynecol Scand. 2022;101:25–36. doi: 10.1111/aogs.14263) Participants in simulation-based team training in obstetric emergencies often report increased confidence in their ability to manage unfolding emergencies that may present in actual practice. However, empirical data that examines the efficacy of such training on impacting clinical outcomes is incomplete. This review assesses the contribution of simulation-based training for health care providers to the outcomes of obstetric emergencies.

A before and after study of the impact of simulation training on practitioner confidence in complex operative deliveries

The aim of this before and after study was to evaluate the efficacy of a complex operative obstetrics course in improving practitioner confidence. The course covered rotational instrumental vaginal delivery, vaginal breech delivery, cervical cerclage, management of postpartum haemorrhage, and complex caesarean section. Participants filled in a pre- and postcourse questionnaire using a Likert scale to rate confidence from 1 (not confident) to 5 (very confident) in 15 key skills. Data were analysed using a two-sample t-test for comparison of means. Data were collected from 67 participants. Practitioner confidence increased across all skills studied. The largest increases in mean confidence scores were seen in classical caesarean section (score increase 2.45; p < 0.05) and management of head entrapment at breech (score increase 2.24; p < 0.05). The course was successful in improving practitioner confidence across a range of obstetric skills. Impact statement What is already known on this subject? Team-based training for obstetric emergencies has been shown to improve practitioner knowledge, team behaviours and patient outcomes. Simulation training in operative vaginal delivery improves operator technique and reduces adverse outcomes for mothers and babies. What do the results of this study add? Hands-on simulator training in complex operative obstetrics improves practitioner confidence in managing a range of obstetric emergencies including those less frequently encountered. These include rotational instrumental delivery, vaginal breech delivery, complex caesarean section, postpartum haemorrhage and cervical cerclage. What are the implications of these findings for clinical practice and/or future research? This study supports the increased use of simulation in advanced obstetric training with an easily replicated cost efficient course. Further research is warranted to determine whether simulation training improves practitioner competence and patient outcomes.

Reassuringly expensive - A commentary on obstetric emergency training in high-resource settings.

The pathophysiologic origins of obstetrical emergencies are complicated and may well be influenced by events prior to conception. Such problems are not likely to be resolved soon, and in the meantime, high-resource countries simply cannot afford to divert more and more money to litigation and the costs of preventable morbidities for either mother or child. It is long past time we tackled these acute care problems where most first occur-the Maternity unit. It is reasonable to ask whether hospitals (and society at large) are getting what they believe they are buying. Training to satisfy a regulation without improving patient outcomes functionally erects one more barrier to the pursuit of optimal patient outcomes. Why then continue squandering limited resources and precious lives if current hospital training is not improving outcomes? In this monograph, I focus on training programs for the management of obstetrical emergencies.

The effects of obstetric emergency team training on patient outcome: A systematic review and meta‐analysis

Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies. Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30min. The included studies were assessed using PRISMA, EPCO, and GRADE. We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33-0.68; one RCT: OR 1.30, 95 CI% 0.39-4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5min (three cohort studies: OR 0.77, 95% CI 0.51-1.19; two RCT: OR 0.87, 95% CI 0.72-1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect. Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.

The Effect of Simulation-Based Vaginal Birth and Obstetrical Emergency Training for Emergency Health Professionals: A Quasi Experimental Study

Aim: The aim of the study is to determine the effect of simulation-based vaginal birth and obstetric emergencies training given to health professionals (physicians and nurses) working in emergency department on their knowledge level, active learning, team collaboration, and satisfaction with learning.&#x0D; Material and Method: This study is a semi-experimental study consisting of pre-test and post-test. The sample of the study consists of health professionals working in the emergency department. It was carried out in the obstetric unit of Medical Simulation Center in a university hospital. Health professional were given training 8 hours on vaginal birth and obstetric emergencies with simulation-based technique with high fidelity simulator with a guided scenario by trainers. The data were collected using 5 forms as follow: Descriptive Form, Survey Questionnaire, Student Satisfaction and Self-Confidence in Simulation Learning Scale, Simulation Design Scale and Educational Practices Questionnaire. Percentage, minimum-maksimun value, average score, and Mc Nemar test were used in the analysis of the data. &#x0D; Results: Compared to pre-training, the post-training percentage of health professionals' correct answers to the questions about “vaginal birth” and “shoulder dystocia”, one of the obstetric emergencies, increased (p

Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study

BackgroundMulti-professional obstetric emergencies training is one promising strategy to improve maternity care. Sustaining training programmes following successful implementation remains a challenge. Understanding, and incorporating, key components within the implementation process can embed interventions within healthcare systems, thereby enhancing sustainability. This study aimed to identify key components influencing sustainability of PRactical Obstetric Multi-Professional Training (PROMPT) in the Philippines, a middle-income setting.MethodsThree hospitals were purposively sampled to represent private, public and teaching hospital settings. Two focus groups, one comprising local trainers and one comprising training participants, were conducted in each hospital using a semi-structured topic guide. Focus groups were audio recorded. Data were analysed using thematic analysis. Three researchers independently coded transcripts to ensure interpretation consistency.ResultsThree themes influencing sustainability were identified; attributes of local champions, multi-level organisational involvement and addressing organisational challenges.ConclusionsThese themes, including potential barriers to sustainability, should be considered when designing and implementing training programmes in middle-income settings. When ‘scaling-up’, local clinicians should be actively involved in selecting influential implementation champions to identify challenges and strategies specific to their organisation. Network meetings could enable shared learning and sustain enthusiasm amongst local training teams. Policy makers should be engaged early, to support funding and align training with national priorities.

A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies.

ObjectiveTo determine the cost-utility of a multi-professional simulation training programme for obstetric emergencies–Practical Obstetric Multi-Professional Training (PROMPT)–with a particular focus on its impact on permanent obstetric brachial plexus injuries (OBPIs).DesignA model-based cost-utility analysis.SettingMaternity units in England.PopulationSimulated cohorts of individuals affected by permanent OBPIs.MethodsA decision tree model was developed to estimate the cost-utility of adopting annual, PROMPT training (scenario 1a) or standalone shoulder dystocia training (scenario 1b) in all maternity units in England compared to current practice, where only a proportion of English units use the training programme (scenario 2). The time horizon was 30 years and the analysis was conducted from an English National Health Service (NHS) and Personal Social Services perspective. A probabilistic sensitivity analysis was performed to account for uncertainties in the model parameters.Main outcome measuresOutcomes for the entire simulated period included the following: total costs for PROMPT or shoulder dystocia training (including costs of OBPIs), number of OBPIs averted, number of affected adult/parental/dyadic quality adjusted life years (QALYs) gained and the incremental cost per QALY gained.ResultsNationwide PROMPT or shoulder dystocia training conferred significant savings (in excess of £1 billion ($1.5 billion)) compared to current practice, resulting in cost-savings of at least £1 million ($1.5 million) per any type of QALY gained. The probabilistic sensitivity analysis demonstrated similar findings.ConclusionIn this model, national implementation of multi-professional simulation training for obstetric emergencies (or standalone shoulder dystocia training) in England appeared to both be cost-saving when evaluating their impact on permanent OBPIs.

Simulation for intrapartum care: from training to novel device innovation.

Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarized the many uses of simulation in obstetric emergencies from training to assessment. It also described the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review also discussed novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Cesarean section training. This study analyzed the financial implications of simulation training and how this may impact the delivery of such training packages, considering that simulation should be developed and utilized as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.

Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance.

Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.

Prevalence of use of highly concentrated oxytocin or "pepper injection" in labor among clinicians undergoing emergency obstetric training in Sierra Leone.

To examine the awareness, prevalence of use, and knowledge of risks of pepper injection (PI), an injection of highly concentrated oxytocin used to augment or induce labor, among clinicians. An anonymous pre- and post-workshop evaluation conducted among 227 clinicians participating in emergency obstetric and newborn care training in Sierra Leone from June to October 2018. Overall, 225 participants completed the surveys. Of these, 198 (88.0%) of clinicians reported awareness of PI, and 123 (54.7%) self-reported prior use, which was highest among midwives (94/129; 72.9%). Before EmONC training, 82 (36.4%) clinicians reported that they were likely to use PI; this decreased to 39 (17.3%) after training (P<0.05). The mean number of participants correctly identifying risks of PI increased from 149 (66.2%) to 204 (90.7%) after training (P<0.05). There was widespread awareness of PI use among clinicians, and prevalent self-reported prior use among midwives. Risk awareness improved after EmONC training, and the proportion of clinicians reporting likelihood of future use decreased. Improper use of oxytocin may be a major contributor to maternal and newborn morbidity and mortality in Sierra Leone. Initiatives to educate clinicians and to regulate and stop the practice are needed.

The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study

BackgroundAntenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products.MethodsTo explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences.ResultsFGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education.ConclusionsFuture interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

BackgroundGlobally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country.MethodsA stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick’s classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score.DiscussionThis stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries.Trial registrationISRCTN98617255, retrospectively registered July 23, 2018.

Spotlight on… mental health

Spotlight on… mental health

The Effectiveness of Simulation-Based Team Training in Obstetrics Emergencies for Improving Technical Skills: A Systematic Review.

This review explores the effectiveness of simulation-based team training in obstetric emergencies for improving technical skills. A literature search was conducted that included all articles to January 2018. A total of 21 articles were included from a potential 1327 articles. Each included study was assessed for impact of the training program using Kirkpatrick's 4-level model. Only the performance of technical skills was evaluated.Five studies reported on acceptance of simulation as an education tool at a level 1. Level 2 outcomes were reported in 7 studies where staff demonstrated improved skills in an educational setting. Three studies reported improved performance in a clinical setting at a level 3. Ten studies were categorized as level 4 and found that simulation learning was translated into improved techniques or maneuvers in reduced time frames in emergency situations of shoulder dystocia and postpartum hemorrhage. There was evidence that neonatal outcomes were improved.

Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession

BackgroundContinuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts.MethodsA training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants.ResultsAfter training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average.ConclusionsOur results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.

The impact of maternity training on knowledge, confidence, and empowerment: A mixed method pilot evaluation.

Maternity training is a critical global issue. In the United Kingdom (UK), the need for safer care and patient safety is emphasized through NHS policy. Health Education England (HEE) recommends that training should support a culture of continuous learning and improvement, particularly in the area of reducing the rates of stillbirths, neonatal and maternity deaths, and other adverse outcomes, such as intrapartum brain injuries. Training has been shown to play a crucial role in improving quality of care and reducing maternal and perinatal mortality and morbidity. This evaluation was undertaken to determine both the immediate and sustained impact of multiprofessional training in cardiotocograph (CTG) interpretation and community-based simulation training in obstetric emergencies: childbirth emergencies in the community (CEC). The impact was measured in terms of practitioner knowledge, confidence, and empowerment immediately pretraining and posttraining and at 12weeks following training. A longitudinal mixed methods design was used. Attendees to maternity training sessions on cardiotocograph interpretation and management of childbirth emergencies in the community provided the sample. Quantitative data were collected using questionnaires to assess knowledge, confidence, and empowerment. Qualitative data were collected using open-ended questions embedded in the questionnaires. Quantitative data were analysed using within-subject t test to compare differences in the dependent variable measures. Qualitative data analysis was guided by Braun and Clarke (2013) method thematic analysis. The combined qualitative and quantitative results lucidly highlight that training positively impacts upon knowledge, confidence, and empowerment, an impact which is observed across three time points. Training in CTG and CEC is effective in improving knowledge, confidence, and empowerment across all groups. Furthermore, the provision of training packages in these subject areas facilitates improvements in the longer term.