Prospective randomized trial of simulation versus didactic teaching for obstetrical emergencies.
BACKGROUND
The objective of this study was to determine whether simulation was more effective than traditional didactic instruction to train crisis management skills to labor and delivery teams.


METHODS
Participants were nurses and obstetric residents (<5 years experience). Both groups were taught management for shoulder dystocia and eclampsia. The simulation group received 3 hours of training in a simulation laboratory, the didactic group received 3 hours of lectures/video and hands-on demonstration. Subjects completed a multiple-choice questionnaire before training and before testing. After 1 month, all teams underwent performance testing as a labor and delivery drill. All drills were video recorded. Team performances were scored by a blinded reviewer using the video recordings and an expert-developed checklist. The data were analyzed using independent samples Student t test and analysis of variance (one way). P value of < or =0.05 was considered to be statistically significant.


RESULTS
There was no statistical difference found between the groups on the pretraining and pretesting multiple-choice questionnaire scores. Performance testing performed as a labor and delivery drill showed statistically significant higher scores for the simulation-trained group for both shoulder dystocia (Sim = 11.75, Did = 6.88, P = 0.002) and eclampsia management (Sim = 13.25, Did = 11.38, P = 0.032).


CONCLUSIONS
In an academic training program, didactic and simulation-trained groups showed equal results on written test scores. Simulation-trained teams had superior performance scores when tested in a labor and delivery drill. Simulation should be used to enhance obstetrical emergency training in resident education.
Daniels
Kay
K
Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. kdaniels@stanford.edu
Arafeh
Julie
J
Clark
Ana
A
Waller
Sarah
S
Druzin
Maurice
M
Chueh
Jane
J
D003162:Competency-Based Education / Q000379:methods; D003198:Computer Simulation; D004420:Dystocia / Q000628:therapy; D004461:Eclampsia / Q000628:therapy; D004509:Education, Nursing, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D008348:Manikins; D007744:Obstetric Labor Complications / Q000628:therapy*; D009773:Obstetric Nursing / Q000193:education*; D009774:Obstetrics / Q000193:education*; D016544:Patient Simulation; D011247:Pregnancy; D011446:Prospective Studies