Changing the landscape of obstetric resident education in low‐ and middle‐income countries using simulation‐based training

Abstract

Objective To evaluate simulation‐based training (SBT) in low‐ and‐middle‐income countries (LMIC) and the long‐term retention of knowledge and self‐efficacy. Methods We conducted an SBT course on the management of postpartum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) in three government teaching hospitals in Guatemala. We evaluated changes in knowledge and self‐efficacy using a multiple‐choice questionnaire for 46 obstetrics/gynecology residents. A paired Student's t test was used to analyze changes at 1 week and 6 months after the SBT. Results There was an increase in scores in clinical knowledge of MCA (p < 0. 001, 95% confidence interval [CI] 0.81–1.49) and SD (p < 0.001, 95% CI 0.41–1.02) 1 week after SBT, and a statistically insignificant increase in PPH scores (p = 0.617, 95% CI −0.96 to 0.60). This increase in scores was maintained after 6 months for MCA (p < 0.001, 95% CI 0.69–1.53), SD (p = 0.02 95% CI 0.07–0.85), and PPH (p = 0.04, 95% CI 0.01–1.26). For MCA and SD, the levels of self‐efficacy were increased 1 week following training (p < 0.001, 95% CI 0.83–2.30 and p = 0.008, 95% CI 0.60–3.92, respectively), and at 6 months (p < 0.001, 95% CI 0.79–2.42 and p = 0.006, 95% CI 0.66–3.81, respectively). There was a slight increase in PPH self‐efficacy scores 1 week after SBT (p = 0.73, 95% CI −6.05 to 4.41), maintained after 6 months (p = 0.38, 95% CI −6.85 to 2.85). Conclusion SBT was found to be an effective and feasible method to increase short‐ and long‐term clinical knowledge and self‐efficacy of obstetric emergencies in LMIC.

Mixed methods evaluation of simulation-based training for postpartum hemorrhage management in Guatemala

“…b "Attending" was translated from the Spanish word for "boss" ("jefe") by us (GO MOMS) [12] demonstrated that SBT was efficacious for use in training in low-resource settings by increasing short and long-term (> 6 month) clinical knowledge and self-efficacy regarding the management of obstetric emergences. In addition, others (PRONTO) have found that SBT can have an impact on local practice patterns, such as reducing the local incidence of cesarean sections [22].…”

“…We and others have published studies [12] evaluating SBT in LMICs with a focus on short and longer-term retention of learning, however there is still a need to better understand the process of implementation and uptake of training into local practice cultures [13]. In order to better elucidate the long-term impact of SBT on obstetric emergencies, this study sought to provide an in-depth look at one institution's experience implementing SBT for the management of postpartum hemorrhage (PPH) in Guatemala.…”

COVID-19 advanced respiratory care educational training programme for healthcare workers in Lesotho: an observational study

“…As such, we transitioned trainings into a traditional offsite 1-day session, which required a modified approach that compressed the training content, limited case-based discussions and reduced practical hands-on experience. Given simulation training along with group problem solving can be more effective at improving performance and knowledge, future traditional trainings will be better served if done over multiple days—or as initially planned over several months—to allow more time for these key complementary approaches 20 21. Based on our challenges facilitating a longer, more varied LDHF training approach, it will be important to monitor how a longer traditional training approach impacts provider participation and costs.…”

Mixed Methods Evaluation of Simulation-Based Training for Postpartum Hemorrhage Management in Guatemala

“…Our ndings agree with those in the literature that B-Lynch suture and UBT are amenable to simulation training in resource-limited settings 20,21 . Prior work by us (GO MOMS) 12 demonstrated that SBT was e cacious for use in training in low-resource settings by increasing short and long term (> 6 month) clinical knowledge and self-e cacy regarding the management of obstetric emergences. In addition, others (PRONTO) have found that SBT can have an impact on local practice patterns, such as a reduction in the local incidence of C-Sect.…”