Retention of skills 2 years after completion of a postpartum hemorrhage simulation training program in rural Rwanda.
OBJECTIVE
To evaluate the long-term retention of skills gained by rural physicians who completed a postpartum hemorrhage simulation-training program.


METHODS
A quasi-experimental pre-post intervention study enrolled a convenience sample of generalist physicians in rural Rwanda. Participants underwent initial simulation training including pre- and post-training testing in February 2012. Simulation drills to assess skill retention were conducted in March 2014. Participants were scored based on their communication, evaluation, and management skills. Median scores and inter-quartile ranges were calculated and the Wilcoxon signed-rank sum test was used to compare the pre-training, post-training, and retention scores. Physician confidence was assessed using a survey.


RESULTS
In total, 11 physicians were enrolled; eight were available for the 2-year skill-retention evaluation. Significant improvements were observed when comparing participants' pre-training and post-training communication (P=0.03), evaluation (P=0.05), and management (P=0.02) scores, and there were no changes between participants' post-training and 2-year communication (P>0.99), evaluation (P=0.16), and management (P=0.46) scores. There were no differences in the self-reported confidence measures across the duration of the study.


CONCLUSIONS
Simulation training is an effective method for teaching postpartum hemorrhage-management skills to generalist physicians in rural areas and skills are retained for at least 2 years. Further studies could determine the optimal time intervals for refresher training.
Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA. Electronic address: lnathan@montefiore.org.
Lisa M
LM
Nathan
Kibogora District Hospital, Kibogora, Rwanda.
Desire
D
Patauli
Kibogora District Hospital, Kibogora, Rwanda.
Damien
D
Nsabimana
Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Peter S
PS
Bernstein
Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Rwanda; Department of Clinical Research, University Teaching Hospital of Kigali, Kigali, Rwanda.
Stephen
S
Rulisa
Department of Obstetrics and Gynecology and Women's Health, Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Dena
D
Goffman
D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D008427:Maternal Health Services; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D015397:Program Evaluation; D019035:Rural Health Services; D012432:Rwanda
Emergency obstetric training; Postpartum hemorrhage; Simulation training