title: Obstetric simulation as a risk control strategy: course design and evaluation.
abstract: BACKGROUND
  Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles.
  
  
  METHODS
  We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires.
  
  
  RESULTS
  The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years.
  
  
  CONCLUSIONS
  A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.
authors.affiliation: Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. rgardener1@partners.org
authors.forename: Roxane
authors.initials: R
authors.lastname: Gardner
authors.forename: Toni B
authors.initials: TB
authors.lastname: Walzer
authors.forename: Robert
authors.initials: R
authors.lastname: Simon
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Raemer
mesh_terms: D003419:Crisis Intervention; D003479:Curriculum; D003625:Data Collection; D004521:Educational Measurement; D004522:Educational Status; D006801:Humans; D007396:Internship and Residency; D009774:Obstetrics / Q000193:education* / Q000592:standards; D010348:Patient Care Team; D016544:Patient Simulation; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012449:Safety; D011795:Surveys and Questionnaires; D014481:United States