title: Myths and realities of training in obstetric emergencies.
abstract: Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: tim.draycott@bristol.ac.uk.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Draycott
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: kate.collins@nbt.nhs.uk.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Collins
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: jo.crofts@bristol.ac.uk.
authors.forename: Joanna F
authors.initials: JF
authors.lastname: Crofts
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: ds7656@bristol.ac.uk.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: c.winter@promptmaternity.org.uk.
authors.forename: Cathy
authors.initials: C
authors.lastname: Winter
authors.affiliation: University of Kansas, School of Medicine, KS, USA. Electronic address: cweiner@kumc.edu.
authors.forename: Carl P
authors.initials: CP
authors.lastname: Weiner
authors.affiliation: Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: fiona.donald@nbt.nhs.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Donald
mesh_terms: D036861:Delivery, Obstetric / Q000193:education*; D004630:Emergencies; D005260:Female; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training / Q000191:economics / Q000379:methods* / Q000592:standards; D033183:Interdisciplinary Communication; D008348:Manikins; D007744:Obstetric Labor Complications / Q000628:therapy*; D011247:Pregnancy; D015397:Program Evaluation; D000066908:Simulation Training
keywords: effective training; implementation; multi-professional; obstetric emergencies; simulation; teamworking