title: Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training.
abstract: BACKGROUND
  It is important to know the decay of knowledge, skills, and confidence over time to provide evidence-based guidance on timing of follow-up training. Studies addressing retention of simulation-based education reveal mixed results. The aim of this study was to measure the level of knowledge, skills, and confidence before, immediately after, and nine months after simulation-based training in obstetric care in order to understand the impact of training on these components.
  
  
  METHODS
  An educational intervention study was carried out in 2012 in a rural referral hospital in Northern Tanzania. Eighty-nine healthcare workers of different cadres were trained in "Helping Mothers Survive Bleeding After Birth", which addresses basic delivery skills including active management of third stage of labour and management of postpartum haemorrhage (PPH). Knowledge, skills, and confidence were tested before, immediately after, and nine months after training amongst 38 healthcare workers. Knowledge was tested by completing a written 26-item multiple-choice questionnaire. Skills were tested in two simulated scenarios "basic delivery" and "management of PPH". Confidence in active management of third stage of labour, management of PPH, determination of completeness of the placenta, bimanual uterine compression, and accessing advanced care was self-assessed using a written 5-item questionnaire.
  
  
  RESULTS
  Mean knowledge scores increased immediately after training from 70 % to 77 %, but decreased close to pre-training levels (72 %) at nine-month follow-up (p = 0.386) (all p-levels are compared to pre-training). The mean score in basic delivery skills increased after training from 43 % to 51 %, and was 49 % after nine months (p = 0.165). Mean scores of management of PPH increased from 39 % to 51 % and were sustained at 50 % at nine months (p = 0.003). Bimanual uterine compression skills increased from 19 % before, to 43 % immediately after, to 48 % nine months after training (p = 0.000). Confidence increased immediately after training, and was largely retained at nine-month follow-up.
  
  
  CONCLUSIONS
  Training resulted in an immediate increase in knowledge, skills, and confidence. While knowledge and simulated basic delivery skills decayed after nine months, confidence and simulated obstetric emergency skills were largely retained. These findings indicate a need for continuation of training. Future research should focus on the frequency and dosage of follow-up training.
authors: Haydom Lutheran Hospital, PO Box 9000 Haydom, Manyara, Tanzania. ejtnelissen@gmail.com.|North Bristol Trust, Southmead Hospital, Bristol, BS10 5NB, United Kingdom. ejtnelissen@gmail.com.|Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. ejtnelissen@gmail.com.
authors: Ellen
authors: E
authors: Nelissen
authors: Haydom Lutheran Hospital, PO Box 9000 Haydom, Manyara, Tanzania. hege.ersdal@safer.net.|Stavanger Acute Medicine Foundation for Education and Research (SAFER), and Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, POB 8100, 4068, Stavanger, Norway. hege.ersdal@safer.net.
authors: Hege
authors: H
authors: Ersdal
authors: Haydom Lutheran Hospital, PO Box 9000 Haydom, Manyara, Tanzania. estomduma@gmail.com.
authors: Estomih
authors: E
authors: Mduma
authors: Centre for International Health, University of Bergen, Årstadveien 21, N-5009, Bergen, Norway. bjorg.olsen@cih.uib.no.|Department of Obstetrics and Gynaecology, Sørlandet Hospital, Engvald Hansens vei 6, 4400, Flekkefjord, Norway. bjorg.olsen@cih.uib.no.
authors: Bjørg
authors: B
authors: Evjen-Olsen
authors: Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. j.e.w.broerse@vu.nl.
authors: Jacqueline
authors: J
authors: Broerse
authors: Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. j.j.m.van_roosmalen@lumc.nl.|Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. j.j.m.van_roosmalen@lumc.nl.
authors: Jos
authors: J
authors: van Roosmalen
authors: Department of Obstetrics & Gynaecology, Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands. jelle.stekelenburg@online.nl.
authors: Jelle
authors: J
authors: Stekelenburg
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000193:education; D004496:Education, Continuing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D009774:Obstetrics / Q000193:education*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012153:Retention, Psychology; D013663:Teaching / Q000379:methods; D013997:Time Factors