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Abbas JR, Chu MMH, Jeyarajah C, Isba R, Payton A, McGrath B, Tolley N, Bruce I. Virtual reality in simulation-based emergency skills training: A systematic review with a narrative synthesis. Resusc Plus 2023; 16:100484. [PMID: 37920857 PMCID: PMC10618508 DOI: 10.1016/j.resplu.2023.100484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
Objective An important role is predicted for virtual reality (VR) in the future of medical education. We performed a systematic review of the literature with a narrative synthesis, to examine the current evidence for VR in simulation-based emergency skills training. We broadly define emergency skills as any clinical skill used in the emergency care of patients across all clinical settings. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The data sources accessed during this study included: PubMed, CINAHL, EMBASE, AMED, EMCARE, HMIC, BNI, PsychINFO, Medline, CENTRAL, SCOPUS, Web of Science, BIOSIS Citation Index, ERIC, ACM Digital Library, IEEE Xplore, and ProQuest Dissertations and Thesis Global. Cochrane's Rob 2 and ROBVIS tools were used during study quality assessment. No ethical review was required for this work. Results Thirty-four articles published between 14th March 1998 and 1st March 2022 were included in this review. Studies were predominantly conducted in the USA and Europe and focussed on a variety of healthcare disciplines including medical, nursing, and allied health. VR education was delivered using head-mounted displays, Cave Automatic Virtual Environment systems, and bespoke setups. These systems delivered education in a variety of areas (emergency medicine, equipment training, obstetrics, and basic/advanced life support). Subjective potential advantages of this technology included realism, replayability, and time-effectiveness. Reports of adverse events were low in frequency across the included studies. Whilst clear educational benefit was generally noted, this was not reflected in changes to patient-based outcomes. Conclusion There may be educational benefit to using VR in the context of simulation-based emergency skills training including knowledge gain and retention, skill performance, acceptability, usability, and validity. Currently, there is insufficient evidence to demonstrate clear cost-effectiveness, or direct improvement of patient or institutional outcomes, at this stage.
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Affiliation(s)
- Jonathan R Abbas
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Michael M H Chu
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Ceyon Jeyarajah
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Rachel Isba
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster LA1 4YW, United Kingdom
- Alder Hey Children's NHS Foundation Trust, Eaton Road Liverpool, L12 2AP, United Kingdom
| | - Antony Payton
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- VREvo Ltd, The University of Manchester Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT
| | - Brendan McGrath
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Neil Tolley
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom
| | - Iain Bruce
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:214-226.e1. [PMID: 37055148 DOI: 10.1016/j.jogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates. TARGET POPULATION Providers working to improve health care for Canadian women and their families; patients and their families. OUTCOMES Simulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition. BENEFITS, HARMS, AND COSTS This modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time. EVIDENCE Articles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords "simulation" and "simulator." The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care professionals working to improve Canadian women's health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs. RECOMMENDATIONS
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Déclaration de consensus n o 434 : Simulation en obstétrique et gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:227-240.e1. [PMID: 37055149 DOI: 10.1016/j.jogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Nomura RMY, Reis FMD, Gonçalves AM, Proença CMD. Obstetric simulation for undergraduate medical education: how to improve students' self-confidence and expectation according to gender. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221625. [PMID: 37098933 PMCID: PMC10176646 DOI: 10.1590/1806-9282.20221625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales "comprehension and preparation" (18 vs. 22, p<0.001), "knowledge of procedures" (14 vs. 20, p<0.001), and "expectation" (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students' gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for "expectation" (median, 24 vs. 22, p<0.001) and "interest" (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for "expectation" (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION Obstetric simulation enhances the improvement of students' self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care.
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Affiliation(s)
- Roseli Mieko Yamamoto Nomura
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Fabiana Medeiros D Reis
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Amanda Menezes Gonçalves
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Carolina Matos de Proença
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
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Mallory LA, Doughty CB, Davis KI, Cheng A, Calhoun AW, Auerbach MA, Duff JP, Kessler DO. A Decade Later-Progress and Next Steps for Pediatric Simulation Research. Simul Healthc 2022; 17:366-376. [PMID: 34570084 DOI: 10.1097/sih.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research. This exercise produced 6 domains critical to progress in the field: (1) prioritization, (2) research methodology and outcomes, (3) academic collaboration, (4) integration/implementation/sustainability, (5) technology, and (6) resources/support/advocacy. This article reflects on and summarizes a decade of progress in the field of pediatric simulation research and suggests next steps in each domain as we look forward, including lessons learned by our collaborative grass roots network that can be used to accelerate research efforts in other domains within healthcare simulation science.
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Affiliation(s)
- Leah A Mallory
- From the Tufts University School of Medicine (L.A.M.), Boston, MA; Department of Medical Education (L.A.M.), The Hannaford Center for Simulation, Innovation and Education; Section of Hospital Medicine (L.A.M.), Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Section of Emergency Medicine (C.B.D.), Department of Pediatrics, Baylor College of Medicine; Simulation Center (C.B.D.), Texas Children's Hospital, Pediatric Emergency Medicine, Baylor College of Medicine; Section of Critical Care Medicine (K.I.D.), Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Departments of Pediatrics and Emergency Medicine (A.C.), University of Calgary, Calgary, Canada; Division of Pediatric Critical Care (A.W.C.), University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY; Section of Emergency Medicine (M.A.A.), Yale University School of Medicine, New Haven, CT; Division of Critical Care (J.P.D.), University of Alberta, Alberta, Canada; and Columbia University Vagelos College of Physicians and Surgeons (D.O.K.), New York, NY
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Measuring Return on Investment for Professional Development Activities. J Nurses Prof Dev 2022; 38:333-339. [DOI: 10.1097/nnd.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maddan C, Forbes M, Campbell-Mitchell M, Rattray C, Bryan L. The Effect of Obstetric Drills Training - Jamaica Core Obstetric Teaching and Training in Emergencies (JOTTIE) on Postpartum Haemorrhage at a Jamaican Teaching Hospital. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221076651. [PMID: 35155812 PMCID: PMC8829713 DOI: 10.1177/23821205221076651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate whether the initiation of JOTTIE, a one day simulation training course focussed on the management of common obstetric emergencies, was associated with a reduction in the morbidity and mortality associated with postpartum haemorrhage (PPH) at the University Hospital of the West Indies (UHWI). STUDY DESIGN We conducted a retrospective comparative study that evaluated the incidence of multiple outcomes related to maternal morbidity secondary to PPH, during the two year period immediately prior to the introduction of JOTTIE (pre course arm, N = 88) or the two year period, one year post introduction (post course arm, N = 103) for all women who had vaginal deliveries complicated by PPH at UHWI. A relationship was said to be statistically significant if p < 0.05. Additionally, the study examined risk factors in relation to severity of haemorrhage. RESULTS Genital tract trauma represented the highest recorded cause of PPH (approximately 71%). The data revealed that patients in the pre training arm were similarly likely to have no adverse outcome in comparison to patients in the post training arm (p = 0.962). There was also no statistically significant relationship between the time period of patient exposure in relation to the JOTTIE course and severity of PPH (p > 0.05). Uterine fibroids and Crohn's disease were the only co-morbidities found to increase the likelihood of severe PPH, at 5.154 times (p = 0.019,OR = 5.154, CI = 1.314-20.212) and 17.848 times (p = 0.085,OR = 17.848,CI = 0.672-474.365), respectively. CONCLUSIONS This study suggests that prior to the introduction of the JOTTIE the rate of maternal morbidity associated with PPH was relatively low at UHWI and there was no significant effect on its management or a significant reduction in maternal morbidity since introduction of the course. Future research on the morbidity related to the other obstetric emergencies addressed at JOTTIE is needed in order to assess the effect of the course as a whole.
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Wagner SM, Bell CS, Gupta M, Mendez-Figueroa H, Ouellette L, Blackwell SC, Chauhan SP. Interventions to decrease complications after shoulder dystocia: a systematic review and Bayesian meta-analysis. Am J Obstet Gynecol 2021; 225:484.e1-484.e33. [PMID: 34019885 DOI: 10.1016/j.ajog.2021.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the outcomes associated with the implementation of simulation exercises to reduce the sequela of shoulder dystocia. DATA SOURCES Electronic databases (Ovid MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature database, and Scopus) were initially queried in June 2020 and updated in November 2020. The following 3 concepts were introduced and refined using the controlled vocabulary of the database: vaginal birth, shoulder dystocia, and simulation training. There were no limitations to the year of publication as part of the search strategy. STUDY ELIGIBILITY CRITERIA We included all studies that reported on the frequency of shoulder dystocia and the associated complications before and after the implementation of interventional exercises to improve outcomes. METHODS Two authors independently assessed the abstracts and full-text articles of all studies for eligibility and evaluated the quality of the included studies using the Newcastle-Ottawa Scale. Any inconsistencies related to study evaluation or data extraction were resolved by a third author. The coprimary outcomes of this systematic review and meta-analysis were neonatal brachial plexus palsy diagnosed following deliveries complicated by shoulder dystocia and persistence of brachial palsy at 12 months or later. The secondary outcomes were the frequency of shoulder dystocia and cesarean delivery. Study effects were combined using a Bayesian meta-analysis and were reported as risk ratios and 95% credible intervals (Crs). RESULTS Of the 372 articles reviewed, 16 publications, which included 428,552 deliveries with 217,713 (50.8%) deliveries during the preintervention and 210,839 (49.2%) deliveries during the postinterventional period, were included in the meta-analysis. The incidence of neonatal brachial plexus palsy after shoulder dystocia decreased from 12.1% to 5.7% (risk ratio, 0.37; 95% Cr, 0.26-0.57; probability of reduction 100%). The overall proportion of neonatal brachial plexus palsy decreased, but with less precision, from 0.3% to 0.1% (risk ratio, 0.53; 95% Cr, 0.21-1.26; probability of reduction 94%). Two studies followed newborns with brachial plexus palsy for at least 12 months. One study that reported on persistent neonatal brachial plexus palsy at 12 months among 1148 shoulder dystocia cases noted a reduction in persistent neonatal brachial plexus palsy from 1.9% to 0.2% of shoulder dystocia cases (risk ratio, 0.13; 95% confidence interval, 0.04-0.49). In contrast, the study that reported on persistent neonatal brachial plexus palsy at 12 months for all deliveries noted that it did not change significantly, namely from 0.3 to 0.2 per 1000 births (risk ratio, 0.77; 95% confidence interval, 0.31-1.90). Following the implementation of shoulder dystocia interventional exercises, the diagnosis of shoulder dystocia increased significantly from 1.2% to 1.7% of vaginal deliveries (risk ratio, 1.39; 95% Cr, 1.19-1.65; probability of increase 100%). Compared with the preimplementation period, the cesarean delivery rate increased postimplementation from 21.2% to 25.9% (risk ratio, 1.22; 95% Cr, 0.93-1.59; probability of increase 93%). We created an online tool (https://ccrebm-bell.shinyapps.io/sdmeta/) that permits calculation of the absolute risk reduction and absolute risk increase attributable to the intervention vis-à-vis the incidence of shoulder dystocia, neonatal brachial plexus palsy, and cesarean deliveries. CONCLUSION Introduction of shoulder dystocia interventional exercises decreased the rate of neonatal brachial plexus palsy per shoulder dystocia case; the data on persistence of neonatal brachial plexus palsy beyond 12 months is limited and contradictory. Implementation of the interventions was associated with an increase in the diagnosis of shoulder dystocia and rate of cesarean deliveries.
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Brogaard L, Glerup Lauridsen K, Løfgren B, Krogh K, Paltved C, Boie S, Hvidman L. The effects of obstetric emergency team training on patient outcome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 101:25-36. [PMID: 34622945 DOI: 10.1111/aogs.14263] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies. MATERIAL AND METHODS Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. SELECTION CRITERIA randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. DATA COLLECTION AND ANALYSIS The included studies were assessed using PRISMA, EPCO, and GRADE. RESULTS We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33-0.68; one RCT: OR 1.30, 95 CI% 0.39-4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51-1.19; two RCT: OR 0.87, 95% CI 0.72-1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect. CONCLUSIONS Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Paltved
- Department of Human Resources, Medical simulation in Central Denmark Region (MidtSim), Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies. PLoS One 2021; 16:e0249031. [PMID: 33755716 PMCID: PMC7987166 DOI: 10.1371/journal.pone.0249031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the cost-utility of a multi-professional simulation training programme for obstetric emergencies-Practical Obstetric Multi-Professional Training (PROMPT)-with a particular focus on its impact on permanent obstetric brachial plexus injuries (OBPIs). DESIGN A model-based cost-utility analysis. SETTING Maternity units in England. POPULATION Simulated cohorts of individuals affected by permanent OBPIs. METHODS A decision tree model was developed to estimate the cost-utility of adopting annual, PROMPT training (scenario 1a) or standalone shoulder dystocia training (scenario 1b) in all maternity units in England compared to current practice, where only a proportion of English units use the training programme (scenario 2). The time horizon was 30 years and the analysis was conducted from an English National Health Service (NHS) and Personal Social Services perspective. A probabilistic sensitivity analysis was performed to account for uncertainties in the model parameters. MAIN OUTCOME MEASURES Outcomes for the entire simulated period included the following: total costs for PROMPT or shoulder dystocia training (including costs of OBPIs), number of OBPIs averted, number of affected adult/parental/dyadic quality adjusted life years (QALYs) gained and the incremental cost per QALY gained. RESULTS Nationwide PROMPT or shoulder dystocia training conferred significant savings (in excess of £1 billion ($1.5 billion)) compared to current practice, resulting in cost-savings of at least £1 million ($1.5 million) per any type of QALY gained. The probabilistic sensitivity analysis demonstrated similar findings. CONCLUSION In this model, national implementation of multi-professional simulation training for obstetric emergencies (or standalone shoulder dystocia training) in England appeared to both be cost-saving when evaluating their impact on permanent OBPIs.
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Fransen AF, van de Ven J, Banga FR, Mol BWJ, Oei SG. Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance. Cochrane Database Syst Rev 2020; 12:CD011545. [PMID: 33325570 PMCID: PMC8094450 DOI: 10.1002/14651858.cd011545.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. OBJECTIVES To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. SEARCH METHODS The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. MAIN RESULTS We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). AUTHORS' CONCLUSIONS Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.
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Affiliation(s)
- Annemarie F Fransen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Joost van de Ven
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, Netherlands
| | - Franyke R Banga
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - S Guid Oei
- Department of Obstetrics and Gynaecology; Department of Electrical Engineering (University of Technology, Eindhoven), Máxima Medical Centre, Veldhoven, Netherlands
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Abbas JR, Kenth JJ, Bruce IA. The role of virtual reality in the changing landscape of surgical training. J Laryngol Otol 2020; 134:1-4. [PMID: 33032666 DOI: 10.1017/s0022215120002078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current coronavirus disease 2019 pandemic has caused unprecedented challenges to surgical training across the world. With the widespread cancellations of clinical and academic activities, educators are looking to technological advancements to help 'bridge the gap' and continue medical education. SOLUTIONS Simulation-based training as the 'gold standard' for medical education has limitations that prevent widespread adoption outside suitably resourced centres. Virtual reality has the potential to surmount these barriers, whilst fulfilling the fundamental aim of simulation-based training to provide a safe, effective and realistic learning environment. CURRENT LIMITATIONS AND INSIGHTS FOR FUTURE The main limitations of virtual reality technology include comfort and the restrictive power of mobile processors. There exists a clear developmental path to address these restrictions. Continued developments of the hardware and software set to deepen immersion and widen the possibilities within surgical education. CONCLUSION In the post coronavirus disease 2019 educational landscape, virtual, augmented and mixed reality technology may prove invaluable in the training of the next generation of surgeons.
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Affiliation(s)
- J R Abbas
- ENT Department, North West Deanery, UK
| | - J J Kenth
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - I A Bruce
- Department of Paediatric ENT, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health University of Manchester, UK
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Whitfill T, Auerbach M, Diaz MCG, Walsh B, Scherzer DJ, Gross IT, Cicero MX. Cost-effectiveness of a video game versus live simulation for disaster training. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:268-273. [DOI: 10.1136/bmjstel-2019-000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
IntroductionDisaster triage training for emergency medical service (EMS) providers is unstandardised. We hypothesised that disaster triage training with the paediatric disaster triage (PDT) video game ‘60 s to Survival’ would be a cost-effective alternative to live simulation-based PDT training.MethodsWe synthesised data for a cost-effectiveness analysis from two previous studies. The video game data were from the intervention arm of a randomised controlled trial that compared triage accuracy in a live simulation scenario of exposed vs unexposed groups to the video game. The live simulation and feedback data were from a prospective cohort study evaluating live simulation and feedback for improving disaster triage skills. Postintervention scores of triage accuracy were measured for participants via live simulations and compared between both groups. Cost-effectiveness between the live simulation and video game groups was assessed using (1) A net benefit regression model at various willingness-to-pay (WTP) values. (2) A cost-effectiveness acceptability curve (CEAC).ResultsThe total cost for the live simulation and feedback training programme was $81 313.50 and the cost for the video game was $67 822. Incremental net benefit values at various WTP values revealed positive incremental net benefit values, indicating that the video game is more cost-effective compared with live simulation and feedback. Moreover, the CEAC revealed a high probability (>0.6) at various WTP values that the video game is more cost-effective.ConclusionsA video game-based simulation disaster triage training programme was more cost-effective than a live simulation and feedback-based programme. Video game-based training could be a simple, scalable and sustainable solution to training EMS providers.
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14
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Pouypoudat L, Tomczyk L, Gauchotte E, Morel O, Bertholdt C. [Intrauterine tamponade: Practices and training assessment]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:409-413. [PMID: 32084572 DOI: 10.1016/j.gofs.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The main objective was to describe the practices of a French center regarding the use of intrauterine tamponade. The secondary objective was to describe the training of residents in the use of intrauterine tamponade (IUT). METHODS This was a practice survey conducted through an anonymous quiz sent to residents in France between May 1, 2018 and July 1, 2019. Responses from first year residents were excluded. The data concerned the practices of the centers (mode of delivery, mode of insertion, ultrasound control, use of vaginal gauze or antibiotic prophylaxis) as well as the feeling of the residents concerning their training in using of the intrauterine tamponade (frequency, training sessions, learning difficulties). RESULTS We obtained 145 responses to represent all regions of France. Responses from 27/28 centres were obtained. All the centres use it during cesarean section and after vaginal delivery. Vaginal gauze is used in 74% of cases and 65% use antibiotic prophylaxis. A specific training during the residentship is described in only 26% of cases and 21% of residents say they have never used an IUT. CONCLUSION Intrauterine tamponade is a technique widely used in France, regardless of the mode of delivery. The training of residents is essential, especially since the simulation is perfectly adapted to the learning for using intrauterine tamponade.
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Affiliation(s)
- L Pouypoudat
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - L Tomczyk
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - E Gauchotte
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - O Morel
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Halamek LP, Cady RAH, Sterling MR. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019; 43:151178. [PMID: 31500845 DOI: 10.1053/j.semperi.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.
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Affiliation(s)
- Louis P Halamek
- Department of Pediatrics and Department of Obstetrics and Gynecology (by courtesy), School of Medicine, Stanford University, Stanford, CA, United States; Johnson Center for Pregnancy and Newborn Services, Stanford, United States.
| | - Robert A H Cady
- PEO Aircraft Carriers, U.S. Navy, Washington, D.C, United States
| | - Michael R Sterling
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
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Sartori E, Ghezzi F, Cromi A, Laganà AS, Garzon S, Raffaelli R, Scambia G, Franchi M, Candiani M, Casarin J, Ciavattini A, Paola RD, Greco P, Guaschino S, Marchesoni D, Milani R, Rizzo N, Venturini PL, Valente E, Vizza E, Zanconato G, Zullo F. Learning climate and quality of Italian training courses in gynecology and obstetrics. Eur J Obstet Gynecol Reprod Biol 2019; 241:13-18. [DOI: 10.1016/j.ejogrb.2019.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/06/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
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17
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Skills training for operative vaginal birth. Best Pract Res Clin Obstet Gynaecol 2019; 56:11-22. [DOI: 10.1016/j.bpobgyn.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
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Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis. Simul Healthc 2019; 13:268-283. [PMID: 29381590 DOI: 10.1097/sih.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.
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Takacs FZ, Radosa JC, Gerlinger C, Findeklee S, Juhasz-Böss I, Solomayer EF, Hamza A. Introduction of a learning model for type 1 loop excision of the transformation zone of the uterine cervix in undergraduate medical students: a prospective cohort study. Arch Gynecol Obstet 2019; 299:817-824. [PMID: 30607581 DOI: 10.1007/s00404-018-5019-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We address the impact of applying loop electrosurgical excision procedure (LEEP) under direct colposcopic vision teaching to our undergraduates using a self-developed simulation model and a standardized assessment to evaluate the progress of learning. METHODS The undergraduate teaching module was composed of a theoretical course on cervical dysplasia, colposcopy, electrosurgery and excisional procedures of the uterine cervix. This was followed by hands-on practical rounds. During the hands-on practice the students performed five "type 1" LEEP under direct colposcopic vision on the self-developed simulator. Based on specimen fragmentation and excision accuracy a score system was established. The students were asked to answer a course evaluation questionnaire. RESULTS The accuracy of the excisions showed a statistically significant improvement during the five training procedures (excision depth 7.34 ± 1.60-8.54 ± 1.67 mm, p = 0.0041; deviation from target cone thickness 0.88 ± 1.16-0.13 ± 0.94 mm, p = 0.0116). The fragmentation of the conus decreased (2.57 ± 1.26-1.29 ± 0.60 pieces, p < 0.0001). All this led to a general improvement of the LEEP score (2.59 ± 1.93-0.84 ± 1.03, p = 0.001). The student's questionnaire revealed a subjective satisfaction and improvement of their knowledge in pathomechanism, diagnosis and therapy of cervical pathologies. CONCLUSION Undergraduate surgical training, in cervical excisional procedure, is a successful method in improving the students' perception and management of cervical pathologies.
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Affiliation(s)
- Ferenc Zoltan Takacs
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany.
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Christoph Gerlinger
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Amr Hamza
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
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Abstract
An obstetric-specific crisis team allows institutions to optimize the care response for patients with emergent maternal or fetal needs. Characteristics of optimal obstetric rapid response teams are team member role designations; streamlined communication; prompt access to resources; ongoing education, rehearsal, and training; and continual team quality analysis. The outcomes must be incorporated into team responses and reinforced in training. Team response provides a key resource to reassure staff, physicians, and patients that prompt crisis care is only a single call away. Data show that team activation is common, improves the care process, and has promise to improve outcomes.
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