Use of simulation based team training for obstetric crises in resident education.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Daniels
Kay
K
Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. k.daniels@stanford.edu
Lipman
Steven
S
Harney
Kimberly
K
Arafeh
Julie
J
Druzin
Maurice
M
D000773:Anesthesia, Obstetrical; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D009773:Obstetric Nursing / Q000193:education*; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D011247:Pregnancy; D011248:Pregnancy Complications; D015397:Program Evaluation