Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training

Abstract

Objectives To explore the effect of obstetric emergency training on knowledge. Furthermore, to assess if acquisition of knowledge is influenced by the training setting or teamwork training.Design A prospective randomised controlled trial.Setting Training was completed in six hospitals in the South West of England, UK and at the Bristol Medical Simulation Centre, UK.Population Midwives and obstetric doctors working for the participating hospitals were eligible for inclusion in the study. A total of 140 participants (22 junior and 23 senior doctors, 47 junior and 48 senior midwives) were studied.Methods Participants were randomised to one of four obstetric emergency training interventions: (1) 1-day course at local hospital, (2) 1-day course at simulation centre, (3) 2-day course with teamwork training at local hospital and (4) 2-day course with teamwork training at simulation centre.Main outcome measures Change in knowledge was assessed by a 185 question Multiple-Choice Questionnaire (MCQ) completed up to 3 weeks before and 3 weeks after the training intervention.Results There was a significant increase in knowledge following training; mean MCQ score increased by 20.6 points (95% CI 18.1-23.1, P < 0.001). Overall, 123/133 (92.5%) participants increased their MCQ score. There was no significant effect on the MCQ score of either the location of training (two-way analysis of variants P = 0.785) or the inclusion of teamwork training (P = 0.965).Conclusions Practical, multiprofessional, obstetric emergency training increased midwives' and doctors' knowledge of obstetric emergency management. Furthermore, neither the location of training, in a simulation centre or in local hospitals, nor the inclusion of teamwork training made any significant difference to the acquisition of knowledge in obstetric emergencies.

What is the impact of multi-professional emergency obstetric and neonatal care training?

“…Ten of the papers were related to the Simulation and Fire-drill Evaluation (SaFE) study and were treated as one intervention [19][20][21][22][23][24][25][26][27][28]. Two articles reporting on the Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno (PRONTO) trial were included (the pilot study and some of the first results pertaining to changes after the second training module) [29,30].…”

“…Thirteen studies had been conducted in [19][20][21][22][23][24][25][26][27][28] 6 DH (L2&L3) -HIC 10 RCT 2a,b,c 3b NHS Foundation Trust, Liverpool, UK [44,45] --HIC 1 Before-after 4b,c Victoria, Australia [46] 7 [48] --LMIC 1 Before-after 1 2b −−− −−− Sub-Saharan Africa (7 countries) [49] --LMIC 1 Before-after 1 2b,c −−− −−− Somaliland, Somalia [50] 3 8 LMIC 1 Before-after 1 2b,c 3a 4b Making it Happen, Bangladesh & India [52] 4 DH (Bangl.) [54] 3 DH; 3 FH 40 LMIC 1 Quasi-experimental 3c CRM based National study, US [58] 15 -HIC 1 RCT 4c Beth Israel Deaconness Medical Center, US [59] 1 TTH -HIC 1 Before-after 2a 4b,c Perinatal Safety Initiative, US [60] 1 TH -HIC 1 Before-after 3a 4b,c Rhode Island Hospital, US [61] 1 -HIC 1 Before-after 4b,c Geneva University Hospital, Switzerland [63] 1 TTH -HIC 1 Before-after 1 2a 3a TeamSTEPPS, US [18] 3 CH -HIC 1 RCT 2a 4c OBCTT, Southeast US [62] 1 TTH -HIC 1 Quasi-experimental before-after 1 2a,b,c −−− −−− OTHER CEmONC, Tanzania [17] 1 DH LMIC 1 Before-after 3c Copenhagen University Hospital, Denmark [64] 1 TTH -HIC 1 Before-after 1 2a,b 3a 4b University of Oporto, Portugal [65] 1 TTH -HIC 1 Before-after 1 2b 3a * In progress -abstracts not included [31,32] DH = district hospital L1 = level 1 −−− = studies not going beyond Kirkpatrick level 2 RH = referral hospital L2 = level 2 (secondary/regional) FH = field hospital TH = tertiary hospital/medical centre L3 = level 3 (tertiary) CH = community hospital TTH = tertiary and teaching hospital included in the studies spans the whole spectrum from tertiary teaching hospitals to community-and field hospitals.…”

“…• PRactical Obstetric Multi-Professional Training (PROMPT) [19][20][21][22][23][24][25][26][27][28][33][34][35][43][44][45][46]; There were also reports on three locally developed 'in-house' training programmes offered in Tanzania, Denmark and Portugal respectively [17,64,65]. The basic and comprehensive emergency obstetric and neonatal care (BEmONC and CeMONC) training run in many low income countries is often based on the World Health Organization (WHO) training reference manuals [66,67].…”

“…A number of studies in the literature reviewed indicated how their authors had evaluated their own programmes according to the four levels of training achievements described by Kirkpatrick [11,14,19,50,63,64,68,76]. The first two levels refer to the reaction of training participants (satisfaction after training) and the knowledge and skills learning of the trainee.…”

“…The third level measures the implementation or application of learned skills and behaviour in clinical practice. The most advanced level relates to the patient effect of training assessed by measurable clinical outcomes [19,73]. In order to distinguish more clearly between diverse indicators that are lumped together at one level (e.g.…”