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Cullinane M, McLachlan HL, Newton MS, Zugna SA, Forster DA. Using the Kirkpatrick Model to evaluate the Maternity and Neonatal Emergencies (MANE) programme: Background and study protocol. BMJ Open 2020; 10:e032873. [PMID: 32014872 PMCID: PMC7045237 DOI: 10.1136/bmjopen-2019-032873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Over 310 000 women gave birth in Australia in 2016, with approximately 80 000 births in the state of Victoria. While most of these births occur in metropolitan Melbourne and other large regional centres, a significant proportion of Victorian women birth in local rural health services. The Victorian state government recently mandated the provision of a maternal and neonatal emergency training programme, called Maternal and Newborn Emergencies (MANE), to rural and regional maternity service providers across the state. MANE aims to educate maternity and newborn care clinicians about recognising and responding to clinical deterioration in an effort to improve clinical outcomes. This paper describes the protocol for an evaluation of the MANE programme. METHODS AND ANALYSIS This study will evaluate the effectiveness of MANE in relation to: clinician confidence, skills and knowledge; changes in teamwork and collaboration; and consumer experience and satisfaction, and will explore and describe any governance changes within the organisations after MANE implementation. The Kirkpatrick Evaluation Model will provide a framework for the evaluation. The participants of MANE, 27 rural and regional Victorian health services ranging in size from approximately 20 to 1000 births per year, will be invited to participate. Baseline data will be collected from maternity service staff and consumers at each health service before MANE delivery, and at four time-points post-MANE delivery. There will be four components to data collection: a survey of maternity services staff; follow-up interviews with Maternity Managers at health services 4 months after MANE delivery; consumer feedback from all health services collected through the Victorian Healthcare Experience Survey; case studies with five regional or rural health service providers. ETHICS AND DISSEMINATION This evaluation has been approved by the La Trobe University Science, Health and Engineering College Human Ethics Sub-Committee. Findings will be presented to project stakeholders in a deidentified report, and disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
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Jomeen J, Jones C, Martin CR, Ledger S, Hindle G, Lambert C. The impact of maternity training on knowledge, confidence, and empowerment: A mixed method pilot evaluation. J Eval Clin Pract 2020; 26:364-372. [PMID: 31273915 DOI: 10.1111/jep.13218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/07/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES 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 12 weeks following training. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Julie Jomeen
- Department of Midwifery and Child Health, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Catriona Jones
- Department of Midwifery and Child Health, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Colin R Martin
- Institute for Clinical and Applied Health Research, Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Sara Ledger
- Baby Lifeline Training, University of Hull, Hull, UK
| | - Grace Hindle
- Baby Lifeline Training, University of Hull, Hull, UK
| | - Carol Lambert
- Department of Midwifery and Child Health, Faculty of Health Sciences, University of Hull, Hull, UK
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Ghi T, Rizzo G. The use of a hybrid mannequin for the modern high-fidelity simulation in the labor ward: the Italian experience of the Ecografia Gestione Emergenze Ostetriche (EGEO) group. Am J Obstet Gynecol 2020; 222:41-47. [PMID: 31323218 DOI: 10.1016/j.ajog.2019.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
Regular training in the management of intrapartum emergencies has been demonstrated to yield measurable benefits in terms of maternal and perinatal outcomes. Thanks to technologic advances, computerized, full-body mannequins have been created and made available for high-fidelity simulation in obstetrics. The technical skills subjected to training are conventionally represented by classical manual maneuvers, which are recommended in the case of instrumental vaginal delivery, shoulder dystocia, or postpartum hemorrhage. During the past few years, manual skills in the labor ward have been increasingly supported by the use of ultrasound, and this has substantially altered the practical management of intrapartum emergencies in real life. Based on this, a new generation of mannequins suitable for both clinical maneuvers and ultrasound examination seems to be the most appropriate tool for the modern high-fidelity simulation in the management of intrapartum complications. The use of these new hybrid clinical ultrasound mannequins may usher in a new era in high-fidelity obstetric simulation and can hopefully optimize the competencies and technical skills of labor ward professionals in the management of obstetric emergencies. It is from this background that at the beginning of 2018, the Ecografia Gestione Emergenze Ostetriche group was founded in Italy. This group has aggregated a multiprofessional labor ward team including obstetricians, midwives, and anesthesiologists under the common philosophy that ultrasound provides an essential added value in the management of obstetric emergencies. Thanks to the use of these mannequins, the multiprofessional Italian Ecografia Gestione Emergenze Ostetriche group has started to run practical workshops to promote the culture of extraordinary synergy of ultrasound and clinical skills as the best approach to handle intrapartum complications.
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Affiliation(s)
- Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
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Performance improvement to address anesthesia hazards. Int Anesthesiol Clin 2020; 58:38-44. [DOI: 10.1097/aia.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hopwood N, Blomberg M, Dahlberg J, Abrandt Dahlgren M. Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:81-88. [PMID: 32404776 DOI: 10.1097/ceh.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes. METHODS Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR). RESULTS Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively "commingling" theoretical knowledge with practical experience to reflect on actions and judgements. DISCUSSION The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.
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Affiliation(s)
- Nick Hopwood
- Dr. Hopwood: Associate Professor, School of International Studies and Education, University of Technology Sydney, Sydney, Australia, and Department of Curriculum Studies, Stellenbosch Universiteit, Stellenbosch, South Africa. Ms. Blomberg: Professor, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, and Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. Ms. Dahlberg: Senior Lecturer, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Ms. Abrandt Dahlgren: Professor in Medical Education, Department of Medicine and Health, Linköping University, Linköping, Sweden
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Hybrid simulation for obstetrics training: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 246:23-28. [PMID: 31927239 DOI: 10.1016/j.ejogrb.2019.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/21/2023]
Abstract
Hybrid simulation is defined as the use of a patient actor combined with a task trainer within the same session. We sought to investigate the level of evidence about the clinical benefits of hybrid simulation training in obstetrics. We searched MEDLINE using the keywords: Obstetrics AND Medical Education AND (Standardized patient OR Hybrid simulation). A total of 155 studies were screened, from which we selected 11 articles were selected from the title and the abstract in PubMed. For each study, data about the type of simulation, the level of evidence according KirkPatrick's hierarchy was collected. There is evidence that clinical benefit for patients exists for Shoulder Dystocia, and Cord prolapse. For Non-technical skills, such as communication or team training, hybrid simulation was also effective. Whether hybrid simulation offers better training for communication and better immersion than high-fidelity simulation for learners remains to be investigated.
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Walsh BM, Auerbach MA, Gawel MN, Brown LL, Byrne BJ, Calhoun A. Community-based in situ simulation: bringing simulation to the masses. Adv Simul (Lond) 2019; 4:30. [PMID: 31890313 PMCID: PMC6925415 DOI: 10.1186/s41077-019-0112-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Simulation-based methods are regularly used to train inter-professional groups of healthcare providers at academic medical centers (AMC). These techniques are used less frequently in community hospitals. Bringing in-situ simulation (ISS) from AMCs to community sites is an approach that holds promise for addressing this disparity. This type of programming allows academic center faculty to freely share their expertise with community site providers. By creating meaningful partnerships community-based ISS facilitates the communication of best practices, distribution of up to date policies, and education/training. It also provides an opportunity for system testing at the community sites. In this article, we illustrate the process of implementing an outreach ISS program at community sites by presenting four exemplar programs. Using these exemplars as a springboard for discussion, we outline key lessons learned discuss barriers we encountered, and provide a framework that can be used to create similar simulation programs and partnerships. It is our hope that this discussion will serve as a foundation for those wishing to implement community-based, outreach ISS.
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Affiliation(s)
- Barbara M Walsh
- 1Department of Pediatrics, Division of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, 818 Harrison Ave, Vose 5, Boston, MA 02118 USA
| | - Marc A Auerbach
- 2Department of Pediatrics, Yale University School of Medicine, New Haven, USA
| | | | - Linda L Brown
- 4Department of Pediatrics and Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Bobbi J Byrne
- 5Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Aaron Calhoun
- 6Department of Pediatrics, University of Louisville School of Medicine, Louisville, USA
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Halamek LP, Cady RAH, Sterling MR. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019; 43:151178. [PMID: 31500845 DOI: 10.1053/j.semperi.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.
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Affiliation(s)
- Louis P Halamek
- Department of Pediatrics and Department of Obstetrics and Gynecology (by courtesy), School of Medicine, Stanford University, Stanford, CA, United States; Johnson Center for Pregnancy and Newborn Services, Stanford, United States.
| | - Robert A H Cady
- PEO Aircraft Carriers, U.S. Navy, Washington, D.C, United States
| | - Michael R Sterling
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
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Cooper N, O'Brien S, Siassakos D. Training health workers to prevent and manage post-partum haemorrhage (PPH). Best Pract Res Clin Obstet Gynaecol 2019; 61:121-129. [DOI: 10.1016/j.bpobgyn.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023]
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Monod C, Buechel J, Gisin S, Abo El Ela A, Vogt DR, Hoesli I. Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program. J Perinat Med 2019; 47:857-866. [PMID: 31494636 DOI: 10.1515/jpm-2019-0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
Abstract
Background Although cesarean sections at full dilatation are increasing, training in delivering a deeply impacted fetal head is lacking among obstetricians. The purpose of the study was to implement and evaluate a theoretical and simulation-based training program for this obstetrical emergency. Methods We developed a training program consisting of a theoretical introduction presenting a clinical algorithm, developed on the basis of the available literature, followed by a simulation session. We used the Kirkpatrick's framework to evaluate the program. A questionnaire was distributed, directly before, immediately and 6 weeks after the training. Self-perceived competencies were evaluated on a 6-point Likert scale. Pre- and post-test differences in the Likert scale were measured with the Wilcoxon signed rank test. Additionally, the training sessions were video recorded and rated with a checklist in relation to how well the algorithm was followed. Results Eleven residents and eight senior physicians took part to the training. More than 40% of participants experienced a comparable situation after the course during clinical work. Their knowledge and self-perceived competencies improved immediately after the training program and 6 weeks later. Major improvements were seen in the awareness of the algorithm and in the confidence in performing the reverse breech extraction (14.3% of the participants felt confident with the maneuver in the pre-training assessment compared with 66.7% 6 week post-training). Conclusion Our theoretical and simulation-based training program was successful in improving knowledge and confidence of the participants in delivering a deeply impacted fetal head during a cesarean section performed at full dilation.
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Affiliation(s)
- Cécile Monod
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Johanna Buechel
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Stefan Gisin
- Department of Anesthesia, University Hospital Basel and Simulation Center SimBa, Basel, Switzerland
| | - Aisha Abo El Ela
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department Clinical Research, University Hospital Basel and University Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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Lenguerrand E, Winter C, Siassakos D, MacLennan G, Innes K, Lynch P, Cameron A, Crofts J, McDonald A, McCormack K, Forrest M, Norrie J, Bhattacharya S, Draycott T. Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial. BMJ Qual Saf 2019; 29:122-134. [PMID: 31302601 PMCID: PMC7045781 DOI: 10.1136/bmjqs-2018-008625] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<75mins). DESIGN Stepped-wedge cluster randomised controlled trial. SETTING Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016. INTERVENTION The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff. MAIN OUTCOME MEASURES The primary outcome was the proportion of term babies with Apgar<75mins. RESULTS 87 204 eligible births (99.2% with an Apgar score), of which 1291 infants had an Apgar<75mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<75mins rate observed in the 12 randomised units was 1.49%, increasing from 1.32% preintervention to 1.59% postintervention. Once adjusted for a secular time trend, the 'intention-to-treat' analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <75mins following PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<75mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate. CONCLUSIONS PROMPT training, as implemented, had no effect on the rate of Apgar <75mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively. TRIAL REGISTRATION NUMBER ISRCTN11640515.
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Affiliation(s)
- Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Cathy Winter
- Department of Women's Health and Children's Health, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, UK
| | | | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karen Innes
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pauline Lynch
- Maternity Unit, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Alan Cameron
- Ian Donald Fetal Medicine Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Joanna Crofts
- Department of Women's Health and Children's Health, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsty McCormack
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark Forrest
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Tim Draycott
- Translational Health Sciences, University of Bristol, Bristol, UK
- Department of Women's Health and Children's Health, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, UK
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Berveiller P, Rousseau A, Tastard M, Raynal P. [An introduction to human factors: From aeronautic to obstetrics]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2019; 47:527-534. [PMID: 31003012 DOI: 10.1016/j.gofs.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 06/09/2023]
Abstract
The theme of human factors is becoming more and more prominent in the healthcare field. Indeed, despite their expertise, healthcare providers display the same limits, those of any human being working in a team, in a system that requires high-reliability. Error is inherent in all human activity. Therefore, the study of human factors makes a perfect sense. The aim of our article is to provide to readers general and recent information on the concept of human factors, and to introduce other related notions such as "error", "fault", non-punishment of error, leadership, crew resource management, situation awareness. Indeed, in some teams, a lack of situation awareness, a poor communication, or an inadequate leadership may lead to a deteriorated clinical situation, leading to a significant and unbearable risk to our pregnant patients. We have a lot to learn from other professional systems that require high-reliability such as aeronautic, military and nuclear field for example. Thus, understanding a teamwork running and the genesis of the errors, developing some notions as illustrated by non-punishment of the error occurrence, debriefings, maintenance of regular staffs, high-fidelity simulation may allow the teams to evolve in a safer system for our pregnant patients.
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Affiliation(s)
- P Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy Saint Germain, 10, rue du champ Gaillard, 78300 Poissy, France; EA7404 (GIG) - UFR Simone Veil, Montigny-Le-Bretonneux, France; Réseau de périnatalité Maternité en Yvelines et Périnatalité Active (MYPA).
| | - A Rousseau
- Département de Maïeutique, UFR Simone Veil, 78180 Montigny-Le-Bretonneux, France; Unité EA 7285 RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », 78180 Montigny-Le-Bretonneux, France
| | - M Tastard
- Officier Pilote de ligne, Boeing 777, Air France, 45 rue de Paris, 95747 Roissy CDG Cedex, France
| | - P Raynal
- Réseau de périnatalité Maternité en Yvelines et Périnatalité Active (MYPA); Service de gynéologie-obstétrique, centre hospitalier de Versailles, 78150 Le Chesnay, France
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Patel MS, Rathi B, Tashfeen K, Yarubi MA. Development and Implementation of Maternity Dashboard in Regional Hospital for Quality Improvement at Ground Level: A Pilot Study. Oman Med J 2019; 34:194-199. [PMID: 31110625 PMCID: PMC6505336 DOI: 10.5001/omj.2019.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives We sought to develop and implement a Maternity Dashboard to improve the quality of health care at the ground level. Methods We conducted a prospective, descriptive cross-sectional study, involving patients with high-risk pregnancies who had been referred to Nizwa Hospital, Oman. The selection of quality indicators was based on the prototype of clinical outcomes from the Royal College of Obstetricians and Gynecologists. The Maternity Dashboard team adapted local parameters and used preselected general parameters, based on clinical observations, to develop the dashboard. Results The issues posing a threat to Nizwa Hospital in becoming a world-class healthcare facility were: overbooked outpatient department, insufficient staff, and more junior doctors compared to senior doctors and consultants. Additionally, being pioneers, naturally, the dashboard development team faced difficulties while handling adverse situations. More time, guidance, and standardization of quality indicators are desirable. Conclusions Following the approval for a Maternity Dashboard in Nizwa Hospital, the data compiled in an Excel sheet are transmitted manually every month for display on the dashboard in the delivery suite. It is intended to make data collected and dissemination completely automated in the future with the help of the Al-Shifa Healthcare Information System. Expansion of the idea of a Maternity Dashboard to other hospitals and specialties at the regional and tertiary level of the health care system in Oman and a comparison of the standard of health care provided between hospitals based on similar quality indicators would be the next milestone.
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Affiliation(s)
- Malini S Patel
- Department of Obstetrics and Gynecology, Nizwa Hospital, A'Dakhiliyah, Oman
| | - Bhawna Rathi
- Department of Obstetrics and Gynecology, Nizwa Hospital, A'Dakhiliyah, Oman
| | - Kaukab Tashfeen
- Department of Obstetrics and Gynecology, Nizwa Hospital, A'Dakhiliyah, Oman
| | - Mansoor Ali Yarubi
- Department of Obstetrics and Gynecology, Nizwa Hospital, A'Dakhiliyah, Oman
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O'Brien SM, Winter C, Burden CA, Boulvain M, Draycott TJ, Crofts JF. Pressure and traction on a model fetal head and neck associated with the use of forceps, Kiwi™ ventouse and the BD Odon Device™ in operative vaginal birth: a simulation study. BJOG 2019; 124 Suppl 4:19-25. [PMID: 28940875 PMCID: PMC7198111 DOI: 10.1111/1471-0528.14760] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
Objective To determine the pressure and traction forces exerted on a model fetal head by the BD
Odon Device, forceps and Kiwi ventouse during simulated births. Design Simulation study. Setting Simulated operative vaginal birth. Population or Sample 84 simulated operative vaginal births. Methods A bespoke fetal mannequin with pressure sensors around the head and strain gauge across
the neck was used to investigate pressure applied over the head, and traction across the
neck during 84 simulated births using the BD Odon Device, non-rotational forceps and
Kiwi ventouse. Main Outcome Measures Peak pressure on the fetal face and lateral aspects of the head during correct use of
the BD Odon Device and forceps. Peak pressure on orbits and neck during misplacement of
the BD Odon Device and forceps. Peak traction force generated until instrument failure
using the BD Odon Device, forceps and Kiwi ventouse. Results When correctly sited and using 80kPa inflation pressure on the cuff, the BD Odon Device
generated a lower peak pressure on the fetal head than forceps (83kPa vs 146kPa). When
instruments were purposefully misplaced over the orbits the BD Odon Device generated a
lower peak pressure on the orbits than forceps (70kPa vs 123kPa). When purposefully
misplaced over the neck the BD Odon Device, compared to forceps, generated a greater
peak pressure on the anterio-lateral aspect of the neck (56kPa vs 17kPa) and a lower
peak pressure on the posterior aspect of the neck (76kPa vs 93kPa) than forceps. In
cases of true cephalic disproportion the BD Odon Device ‘popped-off’ at a
lower traction force than forceps (208N vs 270N). Conclusions In simulated assisted vaginal birth with correctly placed instruments the peak pressure
exerted on the fetal head by a BD Odon Device is lower than pressure exerted by
non-rotational forceps. In cases in which delivery of the fetal head is not possible due
to cephalo-pelvic disproportion lower traction forces could be applied using the BD Odon
Device than with forceps before the procedure was abandoned due to device failure.
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Affiliation(s)
- S M O'Brien
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - C Winter
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK
| | - C A Burden
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - M Boulvain
- Department of Obstetrics & Gynaecology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - T J Draycott
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - J F Crofts
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK
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Draycott T, Kubiak K, Arthur E, Crofts J. Causation of permanent brachial plexus injuries to the anterior arm after shoulder dystocia – Literature review. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043518791897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Not all neonatal brachial plexus injuries should be deemed the fault of the accoucheur. However, there is a small (<10%) subset of neonatal brachial plexus injuries that are related to excessive traction by the accoucheur: permanent injuries to the anterior arm after SD. The position regarding posterior injuries remains predominantly the same; if the injury is to the posterior shoulder, the injury is likely to have been caused by maternal propulsion against the sacral promontory before the foetal head is delivered, rather than excessive and inappropriate traction. However, there is no reliable evidence that a combination of maternal propulsion and diagnostic traction alone causes significant and permanent injury to the anterior shoulder after shoulder dystocia. This was recognised in Deith vs. Lanarkshire where the judge found: that where there is a severe injury to an anterior arm after SD, excessive traction is overwhelmingly likely to be the cause.
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Affiliation(s)
- Tim Draycott
- Department of Women’s Health, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | | | | | - Joanna Crofts
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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67
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Skills training for operative vaginal birth. Best Pract Res Clin Obstet Gynaecol 2019; 56:11-22. [DOI: 10.1016/j.bpobgyn.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
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Kirk L, Bahl R. Nontechnical skills and decision making in operative vaginal delivery. Best Pract Res Clin Obstet Gynaecol 2019; 56:23-34. [PMID: 30826158 DOI: 10.1016/j.bpobgyn.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
Nontechnical skills are defined as social, cognitive and personal resource skills that are necessary to conduct any technical skill safely. Whilst the skills are categorised into three domains: social, cognitive and personal resources, these are dependent on each other and the development and effectiveness of one relies on the other two. Effective nontechnical skills are essential in the safe care of patients in any setting, and their importance can be clearly demonstrated in the safe development of skills in many areas of medicine and surgery. Increasingly the importance of these skills is being recognised in outcomes for patients and staff, and training courses and assessment tools are being developed and used in obstetrics. Understanding of the role of nontechnical skills in labour and especially in operative vaginal births should be embedded across the specialty. Further research is needed in validation of assessment tools for these skills when used in obstetrics.
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Affiliation(s)
- Lisa Kirk
- Department of Obstetrics & Gynaecology, St. Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK
| | - Rachna Bahl
- Department of Obstetrics & Gynaecology, St. Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK.
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Malmut L, Rho ME. Simulation-Based Education for Urgent Medical Complications Common to the Rehabilitation Setting: An Educational Program for Physical Medicine and Rehabilitation Residents. PM R 2019; 11:1272-1277. [PMID: 30779322 DOI: 10.1002/pmrj.12148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/14/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Simulation technology is being increasingly adopted into medical education and is consistently associated with positive effects on knowledge, skills, and patient-related outcomes. There is little evidence on the use of simulation technology for the instruction of urgent medical complications to physical medicine and rehabilitation (PM&R) residents. OBJECTIVE To examine whether a simulation-based educational program can improve PM&R resident confidence and knowledge in the assessment and management of urgent medical complications. DESIGN Pretest-posttest design. SETTING Academic freestanding acute inpatient rehabilitation hospital. PARTICIPANTS Twelve Post-Graduate Year (PGY)-2 PM&R residents at the start of the academic year. METHODS Residents completed an integrated didactic and simulation-based curriculum on the assessment and management of five urgent medical complications: seizures, agitation, ventricular assist device (VAD)-associated complications, sympathetic storming, and autonomic dysreflexia. Simulations were conducted using a high-fidelity manikin. MAIN OUTCOME MEASUREMENTS Surveys and knowledge assessments were completed at baseline and immediately following training. Survey responses were recorded on a Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Multiple-choice knowledge assessments were scored out of 100%. Within-group differences from baseline to postintervention were analyzed. RESULTS There was a positive correlation between baseline experience and baseline confidence scores (r = 0.877). Improved confidence was demonstrated in the assessment and management of all five topics (P < .05). Knowledge assessment scores significantly improved from 57.8% (95% confidence interval [CI] 50.6% to 65.4%) at baseline to 85.0% (95% CI 81.6% to 88.4%) following the course (P < .001). The education program was rated highly by both learners (mean satisfaction score, Likert score [LS] = 4.6) and instructors (mean satisfaction score, LS = 4.5). CONCLUSIONS Application of a simulation-based educational model to the instruction of urgent medical complications to PM&R residents resulted in increased knowledge with added benefits of confidence building and high levels of enjoyment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Laura Malmut
- Shirley Ryan AbilityLab, Northwestern University/Feinberg School of Medicine, Chicago, IL
| | - Monica E Rho
- Shirley Ryan AbilityLab, Northwestern University/Feinberg School of Medicine, Chicago, IL
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The Epidemiology of Brachial Plexus Birth Palsy in the United States: Declining Incidence and Evolving Risk Factors. J Pediatr Orthop 2019; 39:e134-e140. [PMID: 29016426 DOI: 10.1097/bpo.0000000000001089] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The epidemiology of brachial plexus birth palsy (BPBP) in the United States may be changing over time due to population-level changes in obstetric care. METHODS The Kids' Inpatient Database from 1997 to 2012 was analyzed. Annual estimates of BPBP incidence and disease determinant distribution were calculated for the general population and the study population with BPBP. Long-term trends were analyzed. A multivariate logistic regression model was used to quantify the risk associated with each determinant. RESULTS The database yielded a combined total of 5,564,628 sample births extrapolated to 23,385,597 population births. The population incidence of BPBP dropped 47.1% over the 16-year study period, from 1.7 to 0.9 cases per 1000 live births (P<0.001). Female, black, and Hispanic subgroups had moderately increased risks of BPBP. Among children with BPBP, 55.0% had no identifiable risk factor. Shoulder dystocia was the strongest risk factor for BPBP in the regression model [odds ratio (OR), 113.2; P<0.001], although the risk of sustaining a BPBP in the setting of shoulder dystocia decreased from 10.7% in 1997 to 8.3% in 2012 (P=0.006). Birth hypoxia was independently associated with BPBP (OR, 3.1; P<0.001). Cesarean delivery (OR, 0.16; P<0.001) and multiple gestation birth (OR, 0.45; P<0.001) were associated with lower incidence of BPBP. Notably, the rate of cesarean delivery increased by 62.8% during the study period, from 20.9% in 1997 to 34.0% in 2012 (P<0.001). CONCLUSIONS Over a 16-year period, the incidence of BPBP fell dramatically, paralleled by a significant increase in the rate of cesarean delivery. Systemic changes in obstetric practice may have contributed to these trends. As more than half of BPBP cases have no identifiable risk factor, prospective investigation of established risk factors and characterization of new disease determinants are needed to more reliably identify infants at greatest risk. Racial and geographic inequalities in disease burden should be investigated to identify interventional targets. LEVEL OF EVIDENCE Level III-case series.
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71
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Bridging the Gap: Incorporating Simulation into Obstetrics and Gynaecology Undergraduate Medical Education. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:191-196.e2. [DOI: 10.1016/j.jogc.2018.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022]
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Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis. Simul Healthc 2019; 13:268-283. [PMID: 29381590 DOI: 10.1097/sih.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT 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.
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Lepage J, Ceccaldi PF, Remini SA, Plaisance P, Voulgaropoulos A, Luton D. Twin vaginal delivery: To maintain skill - simulation is required. Eur J Obstet Gynecol Reprod Biol 2019; 234:195-199. [PMID: 30711812 DOI: 10.1016/j.ejogrb.2018.12.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/29/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although most societies of obstetrics advocate vaginal delivery of twins, there has been a steady rise in the rate of twin cesarean sections. We risk perhaps losing in a single generation our obstetrical learning and skills because of medicolegal and emotionally charged issues. METHODS We have therefore designed a realistic as possible simulation model of second twin delivery and tested it on residents in obstetrics. FINDINGS Between two trials, we noted a significant improvement in the time required for internal podalic version and breech extraction. We also observed a significant improvement in the confidence score between the two trials. INTERPRETATION We have designed a simulation device that improves obstetrical skills for second twin delivery and which we hope will participate in the comeback of vaginal delivery for this indication and contribute to the fight against the dangerous trend of rising rates of cesarean delivery for twins. Our model completely fits the paradigm of simulation in medical pedagogy.
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Affiliation(s)
- Julien Lepage
- Hôpital Bichat, Maternité Aline de Crepy, APHP, 75018, Paris, France; Université Paris Diderot, Paris 7, Paris, France
| | - Pierre Francois Ceccaldi
- Université Paris Diderot, Paris 7, Paris, France; Hôpital Beaujon, Service de gynécologie obstétrique, APHP, 92110, Clichy, France; Ilumens Paris Diderot, Centre de simulation, Paris, France; DHU Risk and Pregnancy (Paris V and Paris VII University), France
| | | | - Patrick Plaisance
- Université Paris Diderot, Paris 7, Paris, France; Ilumens Paris Diderot, Centre de simulation, Paris, France; Hôpital Lariboisière, Emergency Unit, APHP, 75018, Paris, France
| | | | - Dominique Luton
- Hôpital Bichat, Maternité Aline de Crepy, APHP, 75018, Paris, France; Université Paris Diderot, Paris 7, Paris, France; Ilumens Paris Diderot, Centre de simulation, Paris, France; DHU Risk and Pregnancy (Paris V and Paris VII University), France.
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74
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Simulation Training for Rare Medications in the Intensive Care Unit—A Study with Bivalirudin. Anaesth Intensive Care 2019; 41:242-6. [DOI: 10.1177/0310057x1304100213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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75
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Takacs FZ, Radosa JC, Gerlinger C, Findeklee S, Juhasz-Böss I, Solomayer EF, Hamza A. Introduction of a learning model for type 1 loop excision of the transformation zone of the uterine cervix in undergraduate medical students: a prospective cohort study. Arch Gynecol Obstet 2019; 299:817-824. [PMID: 30607581 DOI: 10.1007/s00404-018-5019-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We address the impact of applying loop electrosurgical excision procedure (LEEP) under direct colposcopic vision teaching to our undergraduates using a self-developed simulation model and a standardized assessment to evaluate the progress of learning. METHODS The undergraduate teaching module was composed of a theoretical course on cervical dysplasia, colposcopy, electrosurgery and excisional procedures of the uterine cervix. This was followed by hands-on practical rounds. During the hands-on practice the students performed five "type 1" LEEP under direct colposcopic vision on the self-developed simulator. Based on specimen fragmentation and excision accuracy a score system was established. The students were asked to answer a course evaluation questionnaire. RESULTS The accuracy of the excisions showed a statistically significant improvement during the five training procedures (excision depth 7.34 ± 1.60-8.54 ± 1.67 mm, p = 0.0041; deviation from target cone thickness 0.88 ± 1.16-0.13 ± 0.94 mm, p = 0.0116). The fragmentation of the conus decreased (2.57 ± 1.26-1.29 ± 0.60 pieces, p < 0.0001). All this led to a general improvement of the LEEP score (2.59 ± 1.93-0.84 ± 1.03, p = 0.001). The student's questionnaire revealed a subjective satisfaction and improvement of their knowledge in pathomechanism, diagnosis and therapy of cervical pathologies. CONCLUSION Undergraduate surgical training, in cervical excisional procedure, is a successful method in improving the students' perception and management of cervical pathologies.
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Affiliation(s)
- Ferenc Zoltan Takacs
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany.
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Christoph Gerlinger
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Amr Hamza
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
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Al-Shahrestani F, Sørensen MS, Andersen SAW. Performance metrics in mastoidectomy training: a systematic review. Eur Arch Otorhinolaryngol 2019; 276:657-664. [DOI: 10.1007/s00405-018-05265-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
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Cacciola TP, Martino M. Simulation in Obstetrics and Gynecology. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tosello B, Blanc J, Kelway C, Pellegrin V, Quarello E, Comte F, Zakarian C, D'Ercole C. [Medical simulation as a tool in the training of perinatal professionals]. ACTA ACUST UNITED AC 2018; 46:530-539. [PMID: 29776841 DOI: 10.1016/j.gofs.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/29/2022]
Abstract
Though technology plays an increasingly important role in modern health systems, human performance remains a major determinant of safety, effectiveness and efficiency of patient care. This is especially true in the delivery room. Thus, the training of professionals must aim not only for the acquisition of theory and practical skills on an individual basis, but also for the learning of teamwork systematically. Training health professionals with simulation enhances their theoretical knowledge and meets formal requirements in literacy, technical skills and communication. Therefore, we intend to explore how, in perinatal care, training with simulation is actually a key teaching tool in initial education and in perpetuation of knowledge. We will approach three main aspects: individual, collective (team) and the impact of simulation in medical practice. The choice of this educational strategy improves the clinical skills that are required for optimal performance in complex, unpredictable and high-stake environments such as the delivery room. Nonetheless, the long term clinical impact of simulation and whether it's modalities, technical or not, are beneficial to the mother and the newborn are areas still to be explored.
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Affiliation(s)
- B Tosello
- Service de médecine néonatale, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; UMR 7268 ADÉS, faculté de médecine de marseille, Aix-Marseille université-EFS-CNRS, 51, boulevard Pierre-Dramard, 13344 Marseille cedex 15, France.
| | - J Blanc
- Service de gynécologie-obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille université, 13284 Marseille, France
| | - C Kelway
- Service d'anesthésie-réanimation, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - V Pellegrin
- Service d'anesthésie-réanimation, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - E Quarello
- Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France; Unité d'échographie et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex 08, France
| | - F Comte
- École universitaire de Maïeutique Marseille Méditerranée, Aix-Marseille université, boulevard Pierre-Dramard, 13015 Marseille, France
| | - C Zakarian
- École universitaire de Maïeutique Marseille Méditerranée, Aix-Marseille université, boulevard Pierre-Dramard, 13015 Marseille, France
| | - C D'Ercole
- Service de gynécologie-obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
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79
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The American Association of Oral and Maxillofacial Surgeons Simulation Program. Oral Maxillofac Surg Clin North Am 2018; 30:195-206. [PMID: 29622313 DOI: 10.1016/j.coms.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patient safety in dental anesthesia has been called into question in recent years. Simulation training has been proposed and developed as one possibility for increasing preparedness and training in cases of adverse events in dental anesthesia. This article presents an overview of the challenges of patient safety in dental anesthesia and how to address them with simulation training. The American Association of Oral and Maxillofacial Surgeons simulation program is unique in its potential to become a standardized, validated competency course with objective grading criteria, mastery-based cooperative learning model, and low facilitator-to-participant ratio, leading to a practical delivery cost structure.
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Impact of a Multidimensional Technical Skills Training Session Before Obstetrics and Gynaecology Clerkship Rotation on Performance and Exposure. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1315-1323. [PMID: 30390945 DOI: 10.1016/j.jogc.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study sought to assess the impact of an obstetrics and gynaecology (OBGYN) multidimensional technical skills training session on medical student self-perceived confidence, objective performance, clinical exposure, and interest in OBGYN. METHODS OBGYN clerkship students were divided into control (i.e., traditional curriculum) and intervention (i.e., additional pre-rotation simulation training in vaginal delivery, suturing and knot tying, speculum and bimanual examinations, and intrapartum cervical examination) groups. Both groups underwent an objective structured clinical examination (OSCE) after the rotation and completed pre- and post-rotation questionnaires to assess confidence, clinical exposure, and interest in OBGYN. The primary outcomes were self-reported confidence and OSCE scores, and the secondary outcomes were clinical exposure and interest in OBGYN. RESULTS A total of 148 students participated. Both groups reported least confidence with vaginal delivery and cervical examinations before the rotation. There was improved self-confidence across all skills after the rotation, with the intervention group demonstrating greater improvement for vaginal delivery (3.36 vs. 3.10; P < 0.05) and cervical examination (3.14 vs. 2.86; P < 0.05). The intervention group also demonstrated a trend towards higher OSCE scores for all skills, but only speculum and bimanual examinations reached statistical significance. The intervention increased exposure from "0 to 5" to "6 to 10" for vaginal delivery and suturing. There was no difference in interest in OBGYN between the two groups. CONCLUSION A technical skills training session before OBGYN clerkship is feasible and has the potential to increase students' confidence, OSCE performance, and hands-on procedural exposure. The optimal combination of skills to be included still needs to be defined.
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Leng OM, Rothwell C, Buckton A, Elmer C, Illing J, Metcalf J. Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:190-195. [PMID: 35519014 DOI: 10.1136/bmjstel-2017-000228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
Background The patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes. Objective To evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital. Methods This study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention. Results The in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia. Conclusion This study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.
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Affiliation(s)
- Owain Michael Leng
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Charlotte Rothwell
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Annamarie Buckton
- Department of Medicine, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Catherine Elmer
- Department of Medicine, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Jan Illing
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Metcalf
- Department of Medicine, University Hospital of North Tees, Stockton-on-Tees, UK
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Walters M, Eubanks A, Weissbrod E, Fischer J, Staat B, Deering S. Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia. AJP Rep 2018; 8:e206-e211. [PMID: 30305983 PMCID: PMC6177338 DOI: 10.1055/s-0038-1673377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery. Objective Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia. Study Design Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied. Videos show providers applying a "normal" (75 N) and "excessive" (150 N) amount of force in both a "calm" and "stressed" delivery. Results Fifty participants rated the amount of force applied. Observers estimated traction, on a scale from 1 to 5, higher in the 150-N deliveries as compared with 75-N deliveries ("calm" environment: 3.1 vs. 2.8, p < 0.001; and "stressed" environment: 3.2 vs. 2.8, p < 0.001). Only 15% of observers rated force "above average" or "excessive" in a "calm" environment, as opposed to 30% of observers in the "stressed" environment. Conclusion Observers are not able to determine when "excessive force" is used and are twice as likely to overestimate the force applied to a fetal head when an average amount of force is used and the delivery environment is stressful. Precis Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.
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Affiliation(s)
- Margaret Walters
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Allison Eubanks
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Elizabeth Weissbrod
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.; Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - John Fischer
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Barton Staat
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Shad Deering
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
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A Novel Approach to Simulation-Based Perineal Repair in Undergraduate Medical Education. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:197-203.e3. [PMID: 30262386 DOI: 10.1016/j.jogc.2018.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/21/2018] [Accepted: 03/24/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is no formalized hands-on teaching of suturing skills for clerkship students during their dedicated obstetrics and gynaecology (OB/GYN) teaching sessions at the University of Toronto. Nevertheless, the students are exposed to suturing during gynaecologic surgery, Caesarean sections, and perineal repairs. As a result, a formal pilot workshop on knot-tying and perineal laceration repair was developed for incorporation into the third-year clerkship curriculum with the goals of increasing students' knowledge and technical skills. METHODS Participants consisted of students enrolled in their OB/GYN clerkship rotation at St. Michael's Hospital at the University of Toronto from December 2016 to August 2017. Prior to the workshop, students' (n = 82) baseline knowledge of perineal lacerations was assessed with a pre-test quiz and their knot-tying speeds (two hand-ties and two instrument ties) were recorded. Students were then taught perineal anatomy, laceration types and repair techniques, suturing, and knot-tying. Under direct supervision, students practiced the technical skills for 45 minutes. Knowledge and knot-tying speeds were then reassessed following the educational session. RESULTS There was a statistically significant improvement in both knowledge (51% to 71%; P < 0.05) and technical skills (258.8 seconds to 197.4 seconds; P < 0.05) after the workshop. Importantly, 94% of students "agreed" or "strongly agreed" that this method of learning was more enjoyable than traditional methods. CONCLUSIONS This pilot project demonstrates that a formal hands-on workshop improves medical knowledge, technical skills, and student satisfaction. This has the potential for students to have increased opportunities at the bedside, with higher patient acceptance and safety.
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Improved clinical management but not patient outcome in women with postpartum haemorrhage-An observational study of practical obstetric team training. PLoS One 2018; 13:e0203806. [PMID: 30256808 PMCID: PMC6157855 DOI: 10.1371/journal.pone.0203806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/28/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Postpartum haemorrhage (PPH) is the most common obstetric emergency. A well-established postpartum haemorrhage protocol in the labour ward is crucial for effective treatment. The aim of the study was to investigate if practical obstetric team training improves the patient outcome and clinical management of PPH. Setting The practical obstetric team training (PROBE) at Linköping University Hospital, Sweden, with approximate 3000 deliveries annually, was studied between the years of 2004–2011. Each team consisted of one or two midwives, one obstetrician or one junior doctor and one nurse assistant. Emergency obstetrics cases were trained in a simulation setting. PROBE was scheduled during work hours at an interval of 1.5 years. Population Pre-PROBE women (N = 419 were defined as all women with vaginal birth between the years of 2004–2007 with an estimated blood loss of ≥1000 ml within the first 24 hours of delivery. Post-PROBE women (N = 483) were defined as all women with vaginal birth between the years of 2008–2011 with an estimated blood loss of ≥1000 ml within the first 24 hours of delivery. The two groups were compared regarding blood loss parameters and management variables using retrospective data from medical records. Results No difference was observed in estimated blood loss, haemoglobin level, blood transfusions or the incidence of postpartum haemorrhage between the two groups. Post-PROBE women had more often secured venous access (p<0.001), monitoring of vital signs (p<0.001) and received fluid resuscitation (p<0.001) compared to pre-PROBE women. The use of uterine massage was also more common among the post-PROBE women compared with the pre-PROBE women (p<0.001). Conclusion PROBE improved clinical management but not patient outcome in women with postpartum haemorrhage in the labour ward. These new findings may have clinical implications since they confirm that training was effective concerning the management of postpartum haemorrhage. However, there is still no clear evidence that simulation training improve patient outcome in women with PPH.
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Deutsch ES, Patterson MD. Simulation Saves the Day (and Patient). Otolaryngol Clin North Am 2018; 52:115-121. [PMID: 30249446 DOI: 10.1016/j.otc.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgeons can use simulation to improve the safety of the systems they work within, around, because of, and despite. Health care is a complex adaptive system that can never be completely knowable; simulation can expose aspects of patient care delivery that are not necessarily evident prospectively, during planning, or retrospectively, during investigations or audits. The constraints of patient care processes and adaptive capacity of health care providers may become most evident during simulations conducted "in situ" using real teams and real equipment, in actual patient care locations.
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Affiliation(s)
- Ellen S Deutsch
- Pennsylvania Patient Safety Authority, 333 Market Street, Harrisburg, PA 17101, USA; ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Mary D Patterson
- Department of Emergency Medicine, Center for Experiential Learning and Simulation, University of Florida, 1104 Newell Drive, Suite 445, Gainesville, FL 32610, USA
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Simulation Training for Residents Focused on Mechanical Ventilation: A Randomized Trial Using Mannequin-Based Versus Computer-Based Simulation. Simul Healthc 2018; 12:349-355. [PMID: 28825930 PMCID: PMC5768222 DOI: 10.1097/sih.0000000000000249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Supplemental digital content is available in the text. Introduction Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances in knowledge into better therapeutic performance in real-life clinical settings continues to lag. High-fidelity simulation with a mannequin allows students to interact in lifelike situations; this may be a valuable addition to traditional didactic teaching. The purpose of this study is to compare computer-based and mannequin-based approaches for training residents on MV. Methods This prospective randomized single-blind trial involved 50 residents. All participants attended the same didactic lecture on respiratory pathophysiology and were subsequently randomized into two groups: the mannequin group (n = 25) and the computer screen–based simulator group (n = 25). One week later, each underwent a training assessment using five different scenarios of acute respiratory failure of different etiologies. Later, both groups underwent further testing of patient management, using in situ high-fidelity simulation of a patient with acute respiratory distress syndrome. Results Baseline knowledge was not significantly different between the two groups (P = 0.72). Regarding the training assessment, no significant differences were detected between the groups. In the final assessment, the scores of only the mannequin group significantly improved between the training and final session in terms of either global rating score [3.0 (2.5–4.0) vs. 2.0 (2.0–3.0), P = 0.005] or percentage of key score (82% vs. 71%, P = 0.001). Conclusions Mannequin-based simulation has the potential to improve skills in managing MV.
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A radiopaque 3D printed, anthropomorphic phantom for simulation of CT-guided procedures. Eur Radiol 2018; 28:4818-4823. [PMID: 29789910 DOI: 10.1007/s00330-018-5481-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop an anthropomorphic phantom closely mimicking patient anatomy and to evaluate the phantom for the simulation of computed tomography (CT)-guided procedures. METHODS Patient CT images were printed with aqueous potassium iodide solution (1 g/mL) on paper. The printed paper sheets were stacked in alternation with 1-mm thick polyethylene foam layers, cut to the patient shape and glued together to create an anthropomorphic abdomen phantom. Ten interventional radiologists performed periradicular infiltration on the phantom and rated the phantom procedure regarding different aspects of suitability for simulating CT-guided procedures. RESULTS Radiopaque printing in combination with polyethylene foam layers achieved a phantom with detailed patient anatomy that allowed needle placement. CT-guided periradicular infiltration on the phantom was rated highly realistic for simulation of anatomy, needle navigation and overall course of the procedure. Haptics were rated as intermediately realistic. Participants strongly agreed that the phantom was suitable for training and learning purposes. CONCLUSIONS A radiopaque 3D printed, anthropomorphic phantom provides a realistic platform for the simulation of CT-guided procedures. Future work will focus on application for training and procedure optimisation. KEY POINTS • Radiopaque 3D printing combined with polyethylene foam achieves patient phantoms for CT-guided procedures. • Radiopaque 3D printed, anthropomorphic phantoms allow realistic simulation of CT-guided procedures. • Realistic visual guidance is a key aspect in simulation of CT-guided procedures. • Three-dimensional printed phantoms provide a platform for training and optimisation of CT-guided procedures.
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Kiely DJ. Obstetric Simulation in Canada: The Need for Commitment and Leadership. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:476-477. [PMID: 29276167 DOI: 10.1016/j.jogc.2017.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 11/18/2022]
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Takeda S. Education and training approaches for reducing maternal deaths in Japan. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.hrp2018-007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University
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Kim T, Vogel RI, Das K. Simulation in shoulder dystocia: does it change outcomes? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:91-95. [DOI: 10.1136/bmjstel-2017-000280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 11/03/2022]
Abstract
BackgroundShoulder dystocia is an obstetrical emergency that requires immediate and appropriate provider response to decrease neonatal morbidity.ObjectiveTo determine whether institution of shoulder dystocia simulation training improves maternal and neonatal outcomes at delivery.Study designThis retrospective cohort study compared maternal and neonatal outcomes before (1 September 2008–31 December 2009) and after (1 January 2010–31 December 2014) a mandatory shoulder dystocia simulation curriculum was instituted. Χ2 and Fisher’s exact tests along with multivariate logistic regression models were conducted to adjust for potential confounding.ResultsOf 8930 vaginal deliveries that met eligibility criteria over the 6-year period, 299 (3.3%) deliveries were complicated by a shoulder dystocia. The adjusted frequency of shoulder dystocia was approximately two times higher after training implementation (1.9% vs 3.8%; adjusted OR=1.80 (1.23 to 2.65), p=0.003). Neonatal outcomes such as brachial plexus injury (5.0% vs 7.7%; p=0.75), clavicle fracture (5.0% vs 4.6%; p=1.00) and humerus fracture (0.0% vs 1.9%; p=1.00) were not statistically different after training. Additionally, no significant differences in episiotomy (5.0% vs 4.6%; p=1.00), postpartum haemorrhage (10.0% vs 12.4%; p=0.80) and severe perineal laceration (10.0% vs 6.6%; p=0.50) were observed.ConclusionsThe overall frequency of shoulder dystocia reportedly doubled after training despite stable operative vaginal delivery and caesarean delivery rates. No significant improvements were seen in maternal or neonatal outcomes after simulation training. As shoulder dystocias are rare events, simulation training may not necessarily improve neonatal outcomes, but it may increase overall provider awareness and intervention.
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Al-Hawash S, Whitehead CL, Farine D. Risk of recurrent shoulder dystocia: are we any closer to prediction? J Matern Fetal Neonatal Med 2018; 32:2928-2934. [DOI: 10.1080/14767058.2018.1450382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Shadha Al-Hawash
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Clare L. Whitehead
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Dan Farine
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Canada
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[Simulation-based learning and internal medicine: Opportunities and current perspectives for a national harmonized program]. Rev Med Interne 2018; 39:414-420. [PMID: 29548580 DOI: 10.1016/j.revmed.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
Simulation-based learning (SBL) is developing rapidly in France and the question of its use in the teaching of internal medicine (IM) is essential. While HAS encourages its integration into medical education, French Young Internists (AJI) set up a working group to reflect on the added-value of this tool in our specialty. Different sorts of SBL exist: human, synthetic and electronic. It enables student to acquire and evaluate technical skills (strengths, invasive procedures, etc.) and non-technical skills (relational, reasoning…). The debriefing that follows the simulation session is an essential time in pedagogical terms. It enables the acquisition of knowledge by encouraging the students' reflection to reshape their reasoning patterns by self-correcting. IM interns are supportive of its use. The simulation would allow young internists to acquire skills specific to our specialty such as certain gestures, complex consulting management, the synthesis of difficult clinical cases. SBL remains confronted with human and financial cost issues. The budgets allocated to the development and maintenance of simulation centres are uneven, making the supply of training unequal on the territory. Simulation sessions are time-consuming and require teacher training. Are faculties ready to train and invest their time in simulation, even though the studies do not allow us to conclude on its pedagogical validity?
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Abstract
Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement.
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Affiliation(s)
- Amanda Burden
- Cooper Medical School of Rowan University, 401 South Broadway Camden, NJ 08103, USA.
| | - Erin White Pukenas
- Cooper Medical School of Rowan University, 401 South Broadway Camden, NJ 08103, USA
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Urbutė A, Paulionytė M, Jonauskaitė D, Machtejevienė E, Nadišauskienė RJ, Dambrauskas Ž, Dobožinskas P, Kliučinskas M. Perceived changes in knowledge and confidence of doctors and midwives after the completion of the Standardized Trainings in Obstetrical Emergencies. MEDICINA-LITHUANIA 2018; 53:403-409. [PMID: 29482880 DOI: 10.1016/j.medici.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting. MATERIALS AND METHODS Data was collected across the majority of hospitals providing secondary and tertiary obstetrical care in Lithuania in 2015. A total of 650 obstetricians-gynecologists and midwives attended the trainings; 388 (response rate 59.7%) of them filled in the initial questionnaire before the trainings, 252 (64.9%) immediately after, 160 (41.2%) 6 weeks after, and 160 (41.2%) 6 months after the trainings, which was the final sample for the analyses. Participants used a Likert-type scale to evaluate their knowledge and confidence about management of urgent obstetrical situations: vacuum-assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, preeclampsia/eclampsia, early preterm labor, and dystocia. We assessed how participants' self-reported knowledge and confidence changed after the trainings (compared to before the trainings) and how long the effect was retained for. RESULTS The mean score of self-reported knowledge in obstetrical emergencies increased immediately after the trainings comparing to the scores before the trainings (P<0.001) and it did not differ further between the three time points after the trainings (i.e. immediately, 6 weeks, and 6 months; P>0.05). The same pattern was observed for self-reported confidence scores. The increase in self-reported knowledge and confidence after the trainings was stable. Moreover, the self-reported knowledge and confidence gains were greater for those participants with lower work experience, although benefit was seen across all experience levels. CONCLUSIONS STrObE improved participants' self-reported knowledge and confidence and lasting positive effects were observed for at least 6 months after the initial trainings. Moreover, the trainings were more beneficial for those with lower work experience, although they benefited all the participants.
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Affiliation(s)
- Aivara Urbutė
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Marija Paulionytė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Eglė Machtejevienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta J Nadišauskienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Žilvinas Dambrauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Dobožinskas
- Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kliučinskas
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Reitter A, Daviss BA, Krimphove MJ, Johnson KC, Schlößer R, Louwen F, Bisits A. Mode of birth in twins: data and reflections. J OBSTET GYNAECOL 2018; 38:502-510. [PMID: 29433366 DOI: 10.1080/01443615.2017.1393402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups. There were no significant differences. Given the similarity of these results with several other larger studies of twin birth, we sought to look at reasons why there is still a rising rate of CS for twin births. We further make suggestions for keeping this rate to a sensible minimum. Impact statement What is already known on this subject? The largest randomised controlled study comparing planned vaginal birth with planned CSs for lower risk twins between 32 and 39 weeks of gestation, showed no added safety from planned CS. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What do the results of this study add? This observational study from a single tertiary centre provides external validation of the twin trial results in a practical day-to-day setting. It also provides insights as to how planned vaginal birth can be developed and maintained, with a key focus on safety and maternal participation in decision making. It does focus on consent and providing accurate data. What are the implications of these findings for clinical practice and/or further research? There are good grounds to encourage vaginal birth for low-risk twin pregnancies. The trend of rising caesarean rates in low-risk twin pregnancies worldwide will erode important skills for the conduct of vaginal births without any clear benefit for mothers or babies. The current situation demands careful thought about implementing innovative training opportunities for younger obstetricians. Finally, we need intelligent responses to many non-evidence-based factors which can drive clinical practice.
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Affiliation(s)
- A Reitter
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - B A Daviss
- b Department of Obstetrics and Gynaecology, Midwifery Division , Montfort Hospital , Ottawa , Canada
| | - M J Krimphove
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - K C Johnson
- c Department of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Canada
| | - R Schlößer
- d Department of Pediatrics, Division Neonatology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - F Louwen
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - A Bisits
- e Department of Obstetrics and Gynecology, Royal Hospital for Women , University of New South Wales , Randwick , Australia
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Abstract
An obstetric-specific crisis team allows institutions to optimize the care response for patients with emergent maternal or fetal needs. Characteristics of optimal obstetric rapid response teams are team member role designations; streamlined communication; prompt access to resources; ongoing education, rehearsal, and training; and continual team quality analysis. The outcomes must be incorporated into team responses and reinforced in training. Team response provides a key resource to reassure staff, physicians, and patients that prompt crisis care is only a single call away. Data show that team activation is common, improves the care process, and has promise to improve outcomes.
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Griswold S, Fralliccardi A, Boulet J, Moadel T, Franzen D, Auerbach M, Hart D, Goswami V, Hui J, Gordon JA. Simulation-based Education to Ensure Provider Competency Within the Health Care System. Acad Emerg Med 2018; 25:168-176. [PMID: 28963862 DOI: 10.1111/acem.13322] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/27/2022]
Abstract
The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes," held on May 16, 2017, in Orlando, Florida. Although simulation-based training is a quality and safety imperative in other high-reliability professions such as aviation, nuclear power, and the military, health care professions still lag behind in applying simulation more broadly. This is likely a result of a number of factors, including cost, assessment challenges, and resistance to change. This consensus subgroup focused on identifying current gaps in knowledge and process related to the use of simulation for developing, enhancing, and maintaining individual provider competency. The resulting product is a research agenda informed by expert consensus and literature review.
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Affiliation(s)
- Sharon Griswold
- Department of Emergency Medicine; Drexel University College of Medicine; Philadelphia PA
| | - Alise Fralliccardi
- Department of Emergency Medicine; University of Connecticut School of Medicine; Hartford CT
| | - John Boulet
- Foundation for Advancement of International Medical Education and Research; Philadelphia PA
| | - Tiffany Moadel
- Department of Emergency Medicine; Hofstra Northwell School of Medicine; Hempstead NY
| | - Douglas Franzen
- Department of Emergency Medicine; University of Washington School of Medicine; Seattle WA
| | - Marc Auerbach
- Department of Emergency Medicine and Pediatrics; Yale University School of Medicine; New Haven CT
| | - Danielle Hart
- Department of Emergency Medicine; Hennepin County Medical Center; St. Paul MN
| | - Varsha Goswami
- Department of Emergency Medicine; Drexel University College of Medicine; Philadelphia PA
| | - Joshua Hui
- Department of Emergency Medicine; Kaiser Permanente Los Angeles Medical Center; Los Angeles CA
| | - James A. Gordon
- MGH Learning Laboratory and Division of Medical Simulation; Department of Emergency Medicine; Massachusetts General Hospital; and the Gilbert Program in Medical Simulation; Harvard Medical School; Boston MA
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