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

Multidisciplinary Obstetric Simulation Training: Experience at KK Women's and Children's Hospital (KKH), Singapore, a Tertiary Referral Centre

Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic.  Results The results showed that both simulation courses increased confidence levels among all learners in the management of obstetric emergencies.  Pre-course, participants were most confident in the management of neonatal resuscitation and severe pre-eclampsia, followed by postpartum haemorrhage. They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech delivery, twin delivery, and uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.

Postpartum hemorrhage: The role of simulation

Postpartum hemorrhage (PPH) persists as a leading cause of maternal death worldwide, and in the United States, most maternal deaths due to hemorrhage are deemed preventable. While essential preparations for hemorrhage include protocols and checklists, implementation science has revealed that it is not enough to merely introduce these tools into units. Simulation affords safe opportunities for practice and produces reliable behavior change, and it does not always need to be highly expensive and resource consuming. We review how simulation can be applied to address a unit's vulnerabilities in identifying, managing, and resolving PPH, as well as considerations for crafting a comprehensive simulation program for your unit.

Safe caesarean sections in South Africa: Is internship training sufficient?

Background. In Africa, the maternal mortality rate after caesarean section (CS) is 50 times higher than that in high-income countries. In South Africa (SA), women who undergo CS have a three times higher mortality rate than those who deliver vaginally. Anaesthetic complications and obstetric haemorrhage are major drivers of poor outcomes, and the case fatality rate for CS at district hospitals is particularly high. Objectives. To assess the adequacy of anaesthetic and obstetric internship training in preparing interns to perform CS independently and safely. Methods. This was an observational cross-sectional survey of all community service officers (CSOs) in KwaZulu-Natal (KZN), SA, in 2020. Data were collected via an electronic survey that comprised 68 questions in 4 domains, covering personal information, obstetric surgical training, obstetric anaesthetic training and support received as a CSO. Results. Surveys were sent to 228 CSOs in KZN, with 160 responses received (70% response rate). Respondents included participants from 8 medical schools and 33 internship facilities across the country. One in 8 interns (n=21/160) did not perform the required 10 CSs. Supervision in theatre was provided by an obstetric specialist for at least 1 CS in n=57/160 (35.62%; 95% confidence interval (CI) 28.54 - 43.39) participants, and n=45/160 (28.13%; 95% CI 21.66 - 35.64) interns never performed an emergency CS. Interns had limited opportunity to be the primary surgeon for complicated cases. Only 1/5 interns performed >5 obstetric general anaesthetics. Conclusions. This survey showed that there are deficiencies in the current CS-related training of interns in SA. A lack of exposure to adequate obstetric surgical training and obstetric general anaesthesia is likely to impact on the performance of CSOs and on the safety of the CS service provided at district hospitals. The content and quality of the CS-related intern training programme needs to be enhanced to improve the competence of CSOs. The Health Professions Council of South Africa (HPCSA)’s stipulations for internship training must be adhered to and should look to include simulation training, basic surgical skills courses and prioritisation of exposure to complicated surgical scenarios