Use of Simulation Based Team Training for Obstetric Crises in Resident Education

Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
Simulation in healthcare: journal of the Society for Simulation in Healthcare (Impact Factor: 1.59). 01/2008; 3(3):154-60. DOI: 10.1097/SIH.0b013e31818187d9
Source: PubMed

ABSTRACT Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap.
Ten L&D teams participated in high fidelity simulation training. A team consisted of two or three nurses, one anesthesia resident and one or two obstetric residents. Each team participated in two scenarios; epidural-induced hypotension followed by an amniotic fluid embolism. Each simulation was followed by a facilitated debriefing. All simulations were videotaped. Clinical performances of the obstetric residents were graded by two reviewers using the videotapes and a faculty-developed checklist. Recurrent errors were analyzed and graded using Health Failure Modes Effects Analysis. All team members completed a course evaluation.
Performance deficiencies of the obstetric residents were identified by an expert team of reviewers. From this list of errors, the "most valuable lessons" requiring further focused teaching were identified and included 1) Poor communication with the pediatric team, 2) Not assuming a leadership role during the code, 3) Poor distribution of workload, and 4) Lack of proper use of low/outlet forceps. Participants reported the simulation course allowed them to learn new skills needed by teams during a crisis.
Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.

1 Follower
  • 11/2014; 5(1). DOI:10.1016/j.tacc.2014.11.004
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    ABSTRACT: This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process by brainstorming, followed by simulation. Two means of adding simulation were investigated as follows: just simulating the process and interrupting the simulation between substeps of the process.By adding simulation to a traditional HFMEA, both multidisciplinary teams identified additional data that were relevant for deeper analysis. The study indicates that simulation has a role in HFMEA. Both ways of using simulation seemed feasible, and our results are not conclusive in selecting one over the other.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 02/2014; 9(1):48-55. DOI:10.1097/SIH.0b013e3182a3defd · 1.59 Impact Factor
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    ABSTRACT: Background Simulation based training is now widely used in health professions education to train both individuals and teams. Initially, most of these training initiatives were conducted in simulation centres, but over time concepts such as in situ and mobile simulation were developed. The idea is to train locally using the normal equipment. In this topical review, we will identify and elaborate on the major factors of importance for learning in the different settings. Facts and fiction of how to conduct cost effective training in the simulation centre, in situ and using mobile simulation will be discussed. Examples of how simulation can be used as a research tool will be presented. Last, this topical review will focus on suggestions for how to optimize training conditions in the different types of settings. Method A search of publications was carried out in January 2012. Discussion and summary Simulation based training in situ/mobile and in centres both have advantages and disadvantages. It is recommended to carefully consider the purpose of training and consider the opportunities (financial, technical and human resources) and based on this to create the training cost effectively. In situ simulation can be used as a diagnostic tool to identify technological, organisational and human challenges.
    08/2012; 2(4):174–179. DOI:10.1016/j.tacc.2012.03.006


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May 20, 2014