title: The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training.
abstract: OBJECTIVE
  To compare learning outcomes of postpartum hemorrhage simulation training based on either instructional design guidelines or best practice.
  
  
  METHODS
  A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013. The instructional design group included 13 teams, whereas the best practice group included seven teams. A standardized task checklist was used for scenario analysis and the proportion of correctly executed tasks compared (post-test minus pretest).
  
  
  RESULTS
  The instructional design group scored higher than the best practice group for total number of tasks completed (median difference 0.46 vs 0.17; P<0.001; effect size [r]=0.72). Similar results were observed for communication (median difference 0.56 vs 0.22; P=0.004; r=0.58), laboratory evaluation (median difference 0.83 vs 0.00; P<0.001; r=0.76), and mechanical management (median difference 0.25 vs -0.15; P=0.048; r=0.39). Speed of learning was also increased. The median differences were 0.20 for the instructional design group compared with 0.05 for the best practice group at 60 seconds (P=0.015; r=0.49), and 0.49 versus 0.26 (P=0.001; r=0.65) at 360 seconds.
  
  
  CONCLUSIONS
  The use of simulation training for postpartum hemorrhage that was based on instructional design guidelines yielded better learning outcomes than did training based on best practice.
authors.affiliation: Faculdade Pernambucana de Saúde and Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Centro de Atenção à Mulher, Recife, Brazil.|School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
authors.forename: Brena C P
authors.initials: BC
authors.lastname: de Melo
authors.affiliation: Faculdade Pernambucana de Saúde and Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Centro de Atenção à Mulher, Recife, Brazil.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Falbo
authors.affiliation: School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
authors.forename: Arno M M
authors.initials: AM
authors.lastname: Muijtjens
authors.affiliation: School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.affiliation: School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: van Merriënboer
mesh_terms: D001364:Awareness; D002983:Clinical Competence; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D017145:Models, Educational; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team; D006473:Postpartum Hemorrhage; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D000066908:Simulation Training / Q000379:methods*
keywords: Education; Instructional design; Postpartum hemorrhage; Simulation training; Situational awareness; Training