Randomised controlled study to assess skill retention at 6 vs 12 months after simulation training in shoulder dystocia.

Introduction: Current evidence suggests annual training in the management of shoulder dystocia is adequate. The aim of this trial is to test our hypothesis that skills start to decline at 6 months after training and further decline at 12 months.

Methods: In this randomised, single-blinded study, 13 obstetricians and 51 midwives were randomly assigned to attend a 1-hour mixed lecture and simulation session on shoulder dystocia management. Training was conducted on group 2 at month '0' and on group 1 at month '6'. Their knowledge scores (primary outcome) were assessed before (pre-training), immediately after the training (at-training) and retested at month '12' (post-training).

Results: Two-way repeated-measures analysis of variance showed a statistically significant interaction between the testing time frame (pre-training, at-training and post-training) on the score (p<0.001), but no significant interaction between the groups on the score (p=0.458).Compared to pre-training, the score increased after the simulation training (at-training) in both group 1 (8.69 vs 14.34, p<0.001) and group 2 (9.53 vs 14.66, p< 0.001), but decreased at 6 months post- training in group 1 (14.34 vs 11.71, p<0.001) and at 12 months post-training in group 2 (14.66 vs 11.96, p< 0.001). However the score was better than before the training. There was no significant difference in the post -training score (11.71vs 11.96, p=0.684) between both groups.

Conclusions: Our study demonstrated that simulation training results in short-term and long-term improvement in shoulder dystocia management however knowledge degrades over time. Ongoing training is suggested at a minimum of 12 months' interval for all members of the obstetrics team including midwives and doctors.