title: Obstetric team simulation program challenges.
abstract: OBJECTIVE
  To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program.
  
  
  METHODS
  The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed.
  
  
  METHODS
  Labor and delivery unit and simulation center.
  
  
  METHODS
  Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses.
  
  
  METHODS
  Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed.
  
  
  RESULTS
  Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendall's W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing.
  
  
  CONCLUSIONS
  Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required.
authors.affiliation: Department of Anesthesiology; Loyola University Health System, Loyola University Stritch School of Medicine. Electronic address: abullough@lumc.edu.
authors.forename: A S
authors.initials: AS
authors.lastname: Bullough
authors.affiliation: Department of Obstetrics and Gynecology; Loyola University Health System, Loyola University Stritch School of Medicine.
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.affiliation: Obstetric and Gynecology Nursing Department; Loyola University Health System, Loyola University Stritch School of Medicine.
authors.forename: T
authors.initials: T
authors.lastname: Boland
authors.affiliation: Department of Obstetrics and Gynecology; Loyola University Health System, Loyola University Stritch School of Medicine.
authors.forename: T P
authors.initials: TP
authors.lastname: Waters
authors.affiliation: Department of Anesthesiology; Loyola University Health System, Loyola University Stritch School of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Kim
authors.affiliation: Clinical Research Office; Loyola University Health System, Loyola University Stritch School of Medicine.
authors.forename: W
authors.initials: W
authors.lastname: Adams
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003479:Curriculum; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D016544:Patient Simulation; D011247:Pregnancy; D015397:Program Evaluation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results
keywords: Obstetric emergency team simulation; Team simulation challenges