title: Emergency obstetric simulation training: how do we know where we are going, if we don't know where we have been?
abstract: BACKGROUND
  Obstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation-based model. Arguments for and against this type of training exist, using both economic and clinical reasoning.
  
  
  OBJECTIVE
  To identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting.
  
  
  METHODS
  A literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes.
  
  
  RESULTS
  Ninety-two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high-fidelity equipment or facilities.
  
  
  CONCLUSIONS
  Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.
authors.affiliation: Department of Postgraduate Medical Education, King Edward Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Calvert
authors.forename: Paul M
authors.initials: PM
authors.lastname: McGurgan
authors.forename: Edward M
authors.initials: EM
authors.lastname: Debenham
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Gratwick
authors.forename: Panos
authors.initials: P
authors.lastname: Maouris
mesh_terms: D001315:Australia; D004630:Emergencies; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000628:therapy*; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team; D011247:Pregnancy; D011256:Pregnancy Outcome; D013663:Teaching / Q000379:methods
keywords: interprofessional teaching; obstetric emergency; simulation; training