Simulation as a new tool to establish benchmark outcome measures in obstetrics

Training Cesarean Section: A Scoping Review

STATEMENT

This study is a scoping review that reviews the existing literature on educational strategies in training of cesarean section. A systematic search was carried out in relevant databases, identifying 28 studies for inclusion. Thematic analysis revealed the following training strategies: simulation-based training (team training, in situ training, technical training), simulators (low-fidelity simulators, high-fidelity simulators), clinical training, e-learning or videos, classroom-based learning (lectures, small groups), and assessment (assessment programs/interventions, assessment of learners). Simulation-based training provides a unique milieu for training in a safe and controlled environment. Simulation-based team training is widely accepted and used in obstetrics and improves nontechnical skills, which are important in emergency cesarean section. High-fidelity simulators are advanced and realistic, but because of the expense, low-fidelity simulators may provide a reasonable method for training surgical skills. The literature in training and assessment of surgical skills in relation to cesarean section is sparse, and more studies are warranted.

Concepts for the Simulation Community: Development of the International Simulation Data Registry

STATEMENT

The past several decades have seen tremendous growth in our understanding of best practices in simulation-based healthcare education. At present, however, there is limited infrastructure available to assist programs in translation of these best practices into more standardized educational approaches, higher quality of care, and ultimately improved outcomes. In 2014, the International Simulation Data Registry (ISDR) was launched to address this important issue. The existence of such a registry has important implications not just for educational practice but also for research. The ISDR currently archives data related to pulseless arrest, malignant hyperthermia, and difficult airway simulations. Case metrics are designed to mirror the American Heart Association's Get With the Guidelines Registry, allowing for direct comparisons with clinical scenarios. This article describes the rationale for the ISDR, and outlines its development. Current data are presented to highlight the educational and research value of this approach. Projected future developments are also discussed.

An Exploration of Student Midwives’ Lived Experiences Regarding Confidence and Satisfaction in Medium-Fidelity Simulation

Background

Newly qualified midwives are expected to exhibit some level of confidence in practice when they enter the clinical environment.

Objective

To explore the lived experiences of student midwives after exposure to medium-fidelity simulation concerning confidence and satisfaction.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Baccalaureate of Nursing Science student midwives at the University of Fort Hare. In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis approach.

Results

Superordinate theme sense of fulfilment elicited six sub-ordinate themes namely 1) Transferability of skills 2) Knowledgeable 3) Equipment used during simulation 4) Realism of simulation 4) Sense of accomplishment 5) Sure/unsure of performance. The use of a standardised patient during the simulation instead of a mannequin prepared participants for the real clinical environment. After being involved in the simulation, participants became more inquisitive regarding the management of the simulated condition. Satisfaction with simulation depended on whether the simulation activity met the student’s expectations, and if the simulation equipment resembled real clinical equipment. Post-partum haemorrhage simulation bridged the gap between theory and practice.

Conclusion

Confidence and satisfaction of student midwives during simulation is depended on the realism of the simulated activity. Exposure to simulated activity increases student knowledge. The student acknowledged that simulation can bridge the gap between theory and practice.

Recent advances of simulation in obstetric anesthesia

PURPOSE OF REVIEW

Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories.

RECENT FINDINGS

Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness.

SUMMARY

Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.