Obstetric complications on deployed operations: a guide for the military surgeon

Developing the military GP using immersive simulation in specialty training

Military general practice requires wider knowledge and more diverse skillset than that defined by the Royal College of General Practitioners curriculum. Following completion of specialty training, military general practitioners (GPs) were returning from mostly civilian training environments feeling deskilled and ill-prepared for their military role. The Academic Department of Military General Practice defined the training gap and used co-creative curriculum development to incorporate military topics throughout the GP specialty training programme. Simulation was identified as a key teaching method employed throughout undergraduate and postgraduate health professional education, which could be used to improve the trainee's learning. The resulting operational preparedness training week used layered teaching methods and feedback to build trainees' knowledge and skills before a final major immersive simulation exercise. This article describes the educational design process in terms of the '10 goal conditions' described by Issenberg for high-fidelity medical simulations leading to effective learning.

Creation and Evaluation of a Cesarean Section Simulator Training Program for Novice Obstetric Surgeons

BACKGROUND

We evaluated a novel simulation-based cesarean section training program to teach critical techniques for cesarean section and hemorrhage management.  Methods: This was a prospective educational intervention. After Institutional Review Board approval, we recruited Obstetrics and Gynecology, Family Medicine, and General Surgery residents at three hospitals. All participants received didactic education. Participants were then randomized into two arms with one group to receive task-trainer based training and the other no training. Afterwards, all residents had their performance of a complete cesarean section and management of a post-partum hemorrhage evaluated on a high-fidelity simulator. Evaluators were blinded to randomization.

EXPERIENCE

Thirty-three participants were recruited between July 2017 and January 2019. There were 19 trainees in the control group and 14 in the intervention group. The intervention group scored significantly higher on performance of the cesarean delivery (p-value 0.007), hemorrhage management (p-value 0.0002), and overall skill (p-value 0.008). There were no differences in the other categories.

CONCLUSION

Participants trained with a combination of didactic education and task-trainers versus didactic education alone performed significantly better on all procedural aspects of a cesarean section and hemorrhage management on a high-fidelity simulator, demonstrating that simulation-based training allows trainees to gain procedural experience while decreasing patient risk.