Obstetric skills drills: evaluation of teaching methods.
OBJECTIVE
To determine the most effective method of delivering training to staff on the management of an obstetric emergency.


METHODS
The research was conducted in a District General Hospital in the UK, delivering approximately 3500 women per year. Thirty-six staff, comprising of junior and senior medical and midwifery staff were included as research subjects. Each of the staff members were put into one of six multi-professional teams. Effectively, this gave six teams, each comprising of six members.


METHODS
Three teaching methods were employed. Lecture based teaching (LBT), simulation based teaching (SBT) or a combination of these two (LAS). Each team of staff were randomly allocated to undertake a full day of training in the management of Post Partum Haemorrhage utilising one of these three teaching methods. Team knowledge and performance were assessed pre-training, post training and at three months later. In addition to this assessment of knowledge and performance, qualitative semi-structured interviews were carried out with 50% of the original cohort one year after the training, to explore anxiety, confidence, communication, knowledge retention, enjoyment and transferable skills.


RESULTS
All teams improved in their performance and knowledge. The teams taught using simulation only (SBT) were the only group to demonstrate sustained improvement in clinical management of the case, confidence, communication skills and knowledge. However, the study did not have enough power to reach statistical significance. The SBT group reported transferable skills and less anxiety in subsequent emergencies. SBT and LAS reported improved multidisciplinary communication. Although tiring, the SBT was enjoyed the most.


CONCLUSIONS
Obstetrics is a high risk speciality, in which emergencies are to some extent, inevitable. Training staff to manage these emergencies is a fundamental principal of risk management. Traditional risk management strategies based on incident reporting and event analysis are reactive and not always effective. Simulation based training is an appropriate proactive approach to reducing errors and risk in obstetrics, improving teamwork and communication, whilst giving the student a multiplicity of transferable skills to improve their performance.
Birch
L
L
Practice Development and Research Unit, Duchess of Westminster Wing, Arrowe Park Hospital, Upton, Wirral, Cheshire CH49 5PE, United Kingdom. linda.birch@whnt.nhs.uk
Jones
N
N
Doyle
P M
PM
Green
P
P
McLaughlin
A
A
Champney
C
C
Williams
D
D
Gibbon
K
K
Taylor
K
K
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D004509:Education, Nursing, Continuing / Q000379:methods* / Q000592:standards; D004630:Emergencies / Q000451:nursing; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007400:Interprofessional Relations; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology; D009773:Obstetric Nursing / Q000193:education*; D010348:Patient Care Team; D006473:Postpartum Hemorrhage / Q000451:nursing*; D018794:Problem-Based Learning / Q000379:methods* / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D012308:Risk Management; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods* / Q000592:standards; D006113:United Kingdom