title: Using simulation training to improve shoulder dystocia documentation.
abstract: OBJECTIVE
  To estimate whether shoulder dystocia documentation could be improved with a simulation-based educational experience.
  
  
  METHODS
  Obstetricians at our institution (n=71) participated in an unanticipated simulated shoulder dystocia followed by an educational debriefing session. A second shoulder dystocia simulation was completed at a later date. Delivery notes were a required component of each simulation. Notes were evaluated using a standardized checklist for 16 key components. One point was awarded for each element present. Wilcoxon signed rank tests were used to compare documentation between simulations.
  
  
  RESULTS
  Participants consisted of 43 (61%) attending and 28 (39%) resident physicians. Ages ranged from 25-63 years (mean+/-standard deviation 37.0+/-9.0), and 75% were female. Years of obstetric experience for our attendings ranged from 4 to 31 years (14.5+/-8.1). Documentation scores were significantly improved after training. Attendings' baseline documentation scores were 8.5+/-2.2 and improved to 9.4+/-2.3, P=.03. Residents' documentation scores also improved (9.0+/-2.1 compared with 10.6+/-2.2, P=.001). In particular, improvement was seen in two components of documentation: 1) providers present for shoulder dystocia (P=.007) and 2) which shoulder was anterior (P<.001). No improvement was seen in standard delivery note components (eg, date, time) or infant characteristics (eg, weight, Apgar scores).
  
  
  CONCLUSIONS
  Although we showed a significant improvement in the quality of documentation through this simulation program, notes were still suboptimal. Use of standardized forms for shoulder dystocia delivery notes may provide the best solution to ensure appropriate documentation.
  
  
  METHODS
  II.
authors.affiliation: From the Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: Dena
authors.initials: D
authors.lastname: Goffman
authors.forename: Hye
authors.initials: H
authors.lastname: Heo
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chazotte
authors.forename: Irwin R
authors.initials: IR
authors.lastname: Merkatz
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004282:Documentation; D004420:Dystocia; D005260:Female; D006801:Humans; D007318:Inservice Training; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009774:Obstetrics / Q000193:education*; D016544:Patient Simulation; D011247:Pregnancy