title: Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial.
abstract: OBJECTIVE
  To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact.
  
  
  METHODS
  Investigator-initiated single-centre randomised superiority educational trial.
  
  
  METHODS
  Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark.
  
  
  METHODS
  100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology.
  
  
  METHODS
  Two multiprofessional simulations (clinical management of an emergency caesarean section and a postpartum haemorrhage scenario) were conducted in teams of 10 in the ISS versus the OSS setting.
  
  
  METHODS
  Knowledge assessed by a multiple choice question test.
  Individual outcomes: scores on the Safety Attitudes Questionnaire, stress measurements (State-Trait Anxiety Inventory, cognitive appraisal and salivary cortisol), Intrinsic Motivation Inventory and perceptions of simulations. Team outcome: video assessment of team performance. Organisational impact: suggestions for organisational changes.
  
  
  RESULTS
  The trial was conducted from April to June 2013. No differences between the two groups were found for the multiple choice question test, patient safety attitude, stress measurements, motivation or the evaluation of the simulations. The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group. Expert video assessment of team performance showed no differences between the ISS versus the OSS group. The ISS group provided more ideas and suggestions for changes at the organisational level.
  
  
  CONCLUSIONS
  In this randomised trial, no significant differences were found regarding knowledge, patient safety attitude, motivation or stress measurements when comparing ISS versus OSS. Although participant perception of the authenticity of ISS versus OSS differed significantly, there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes.
  
  
  BACKGROUND
  NCT01792674.
authors.affiliation: Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jette Led
authors.initials: JL
authors.lastname: Sørensen
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
authors.affiliation: Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Rosthøj
authors.affiliation: Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Herlev, Denmark.
authors.forename: Doris
authors.initials: D
authors.lastname: Østergaard
authors.affiliation: University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.
authors.forename: Vicki
authors.initials: V
authors.lastname: LeBlanc
authors.affiliation: Department of Obstetrics, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Johansen
authors.affiliation: Department of Anaesthesiology, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Ekelund
authors.affiliation: Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Liis
authors.initials: L
authors.lastname: Starkopf
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Lindschou
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.affiliation: Laboratory of Neuropsychiatry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Weikop
authors.affiliation: Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D002983:Clinical Competence; D003718:Denmark; D004521:Educational Measurement; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D017145:Models, Educational; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: MEDICAL EDUCATION & TRAINING; OBSTETRICS; in situ simulation; interprofessional; patient simulation