Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study.

Background: Multi-professional obstetric emergencies training is one promising strategy to improve maternity care. Sustaining training programmes following successful implementation remains a challenge. Understanding, and incorporating, key components within the implementation process can embed interventions within healthcare systems, thereby enhancing sustainability.

Skills training for operative vaginal birth.

Skilled, safe operative vaginal birth can substantially improve maternal and neonatal outcomes arising from complications in the second stage of labour and should be available in a diverse range of maternity settings for women across the world. Operative vaginal births are complex, requiring a combination of good technical skills, non-technical skills as well as sensitivity from the accoucher. It is axiomatic that accouchers should be adequately trained and simulation-based training is a promising strategy to improve outcomes and increase the rates of operative vaginal birth.

A rapid cycle method for local adaptation of an obstetric emergencies training program.

Objective: To describe the adaptation of an obstetric emergencies training program to align with local clinical practice.

Methods: A feasibility study was conducted to investigate the potential implementation of the PRactical Obstetric Multi-Professional Training (PROMPT) program at eight urban tertiary hospitals in the Philippines. Multi-professional teams attended a 2-day course on September 23 and 24, 2015, that comprised a demonstration PROMPT course (day 1) and a Train-the-Trainers session (day 2).

The cost of local, multi-professional obstetric emergencies training.

Introduction: We aim to outline the annual cost of setting up and running a standard, local, multi-professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi-Professional Training), at Southmead Hospital, Bristol, UK - a unit caring for approximately 6500 births per year.

Material And Methods: A retrospective, micro-costing analysis was performed. Start-up costs included purchasing training mannequins and teaching props, printing of training materials and assembly of emergency boxes (real and training).

Laparoscopic simulation training in gynaecology: Current provision and staff attitudes - a cross-sectional survey.

The objectives of this study were to explore current provision of laparoscopic simulation training, and to determine attitudes of trainers and trainees to the role of simulators in surgical training across the UK. An anonymous cross-sectional survey with cluster sampling was developed and circulated. All Royal College of Obstetricians and Gynaecologists (RCOG) Training Programme Directors (TPD), College Tutors (RCT) and Trainee representatives (TR) across the UK were invited to participate.

Myths and realities of training in obstetric emergencies.

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable.

Curriculum development for basic gynaecological laparoscopy with comparison of expert trainee opinions; prospective cross-sectional observational study.

Objective: To develop content for a basic laparoscopic curriculum in gynaecology.

Study Design: Prospective cross-sectional observational study. Modified Delphi method with three iterations undertaken by an invited group of national experts across the United Kingdom (UK).

Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers' perspectives.

Introduction: Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved.

Methods: A qualitative study of consultant-led maternity units in an English region.

What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training.

We describe lessons for safety from a synthesis of seven studies of teamwork, leadership and team training across a healthcare region. Two studies identified successes and challenges in a unit with embedded team training: a staff survey demonstrated a positive culture but a perceived need for greater senior presence; training improved actual emergency care, but wide variation in team performance remained. Analysis of multicenter simulation records showed that variation in patient safety and team efficiency correlated with their teamwork but not individual knowledge, skills or attitudes.

Implementation of laparoscopic virtual-reality simulation training in gynaecology: a mixed-methods design.

Objectives: Virtual-reality (VR) training has been demonstrated to improve laparoscopic surgical skills in the operating theatre. The incorporation of laparoscopic VR simulation into surgical training in gynaecology remains a significant educational challenge. We undertook a pilot study to assess the feasibility of the implementation of a laparoscopic VR simulation programme into a single unit.

Retention of factual knowledge after practical training for intrapartum emergencies.

Objective: To determine knowledge retention 1 year after training for intrapartum emergencies.

Methods: Training was undertaken in 6 hospitals and the Bristol Medical Simulation Centre, UK, between November 2004 and March 2005. Participants (22 junior and 23 senior doctors, 47 junior and 48 senior midwives) were randomly recruited from participating hospitals and underwent practical training at their local hospital or simulation center with or without additional teamwork training.

Development of maternity dashboards across a UK health region; current practice, continuing problems.

Objective: To assess the development of local clinical dashboards in line with UK national guidance and to identify ongoing issues being faced by maternity units, across an entire health region, in developing quality assurance systems.

Study Design: A mixed-methods study involving all consultant-led maternity units in the South West of England Strategic Health Authority region (SWSHA). An electronic survey, followed by semi-structured interviews with the lead obstetrician and risk management midwife (or equivalent) of each maternity unit, to investigate methods employed to monitor outcomes locally, particularly the development of tools including maternity dashboards.

Intrapartum care quality indicators: a systematic approach for achieving consensus.

Objective: To identify published maternity intrapartum quality indicators and rationalise them to a core set.

Study Design: Prospective qualitative consensus group exercise. A literature search identified sets of intrapartum quality indicators in the English language.

Validation of virtual reality simulation for obstetric ultrasonography: a prospective cross-sectional study.

Introduction: Ultrasonography is an important skill for obstetricians and gynecologists; however, trainees have highlighted ultrasonography as an area of deficiency in their training. We undertook a prospective cross-sectional comparative study to assess content and construct validity of an ultrasound virtual reality (VR) simulator (UltraSim).

Methods: Twenty-six physicians and sonographers of varied ultrasonography experience were recruited and divided into trainees (no formal ultrasonography training) and expert (certified) categories.

Teamwork for clinical emergencies: interprofessional focus group analysis and triangulation with simulation.

Our purpose was to investigate health care professionals' beliefs about effective teamwork in medical emergencies based on their experiences. We used framework analysis of interprofessional focus groups in four secondary and tertiary maternity units. The participants were randomly selected senior and junior doctors, senior and junior midwives, and health care assistants, in five groups of 5 to 7 participants each.

Evaluating the impact of simulation on translational patient outcomes.

Introduction: A long and rich research legacy shows that under the right conditions, simulation-based medical education (SBME) is a powerful intervention to increase medical learner competence. SBME translational science demonstrates that results achieved in the educational laboratory (T1) transfer to improved downstream patient care practices (T2) and improved patient and public health (T3).

Method: This is a qualitative synthesis of SBME translational science research (TSR) that employs a critical review approach to literature aggregation.

Team communication with patient actors: findings from a multisite simulation study.

Introduction: Patient satisfaction is an important healthcare outcome and communication with clinical staff is an important determinant. Simulation could identify problems and inform corrective action to improve patient experience.

Methods: One hundred eight randomly selected maternity professionals in 18 teams were videoed managing a patient-actor with a simulated emergency.

The use of simulation to teach clinical skills in obstetrics.

Obstetrical practice demands sensitivity, clinical skill, and acumen. Obstetrical emergencies are rare occurrences and are most appropriately dealt with by experienced staff. Simulation provides an opportunity to gain this experience without patient risk and furthermore builds confidence and satisfaction amongst learners.

The management of a simulated emergency: better teamwork, better performance.

Objectives: To determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours.

Methods: Design - Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting - Six secondary and tertiary Maternity Units in Southwest England.

Prospective evaluation of a continuous monitoring and quality-improvement system for reducing adverse neonatal outcomes.

Objective: Our objective was to evaluate a prospective monitoring and quality improvement system for studying trends in the rates of an adverse neonatal outcome, the low Apgar scores (Apgar score <7).

Study Design: A cumulative sum (CUSUM) chart-based system was used to monitor the rate of low Apgar scores over 2 years. Root cause analysis (RCA) was used to investigate for causes of periods of increased low Apgar score rates.

Observations from 450 shoulder dystocia simulations: lessons for skills training.

Poor neonatal outcomes after shoulder dystocia have been associated with inappropriate management. Until there are significant developments in the prediction and subsequent prevention of shoulder dystocia, improving shoulder dystocia management through practical training may be the most effective method of reducing the associated morbidity and mortality. Four hundred fifty simulated shoulder dystocia scenarios, managed by 95 midwives and 45 doctors from six U.

Improving neonatal outcome through practical shoulder dystocia training.

Objective: To compare the management of and neonatal injury associated with shoulder dystocia before and after introduction of mandatory shoulder dystocia simulation training.

Methods: This was a retrospective, observational study comparing the management and neonatal outcome of births complicated by shoulder dystocia before (January 1996 to December 1999) and after (January 2001 to December 2004) the introduction of shoulder dystocia training at Southmead Hospital, Bristol, United Kingdom. The management of shoulder dystocia and associated neonatal injuries were compared pretraining and posttraining through a review of intrapartum and postpartum records of term, cephalic, singleton births in which difficulty with the shoulders was recorded during the two study periods.

Management of shoulder dystocia: skill retention 6 and 12 months after training.

Objective: To assess skill retention 6 and 12 months after shoulder dystocia training.

Methods: Midwives and doctors from six United Kingdom hospitals attended a 40-minute workshop on shoulder dystocia management. Participants managed a standardized simulation before and 3 weeks, 6 months, and 12 months afterward.

Pattern and degree of forces applied during simulation of shoulder dystocia.

Objective: The objective of the study was to determine the level and pattern of forces applied during simulated shoulder dystocia.

Study Design: One hundred forty staff (95 midwives, 45 obstetricians) were randomized from 6 UK hospitals. Applied delivery force was measured during a standardized simulated shoulder dystocia.