Does Repeated Exposure to Critical Situations in a Screen-Based Simulation Improve the Self-Assessment of Non-Technical Skills in Postpartum Hemorrhage Management?

Abstract

Background. Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Non-technical skills (e.g. communication) are now recognized as a contributing factor to medical safety. In the field of simulation, screen-based simulations are currently very popular with computer/technological development. This study evaluates a screen-based simulation device, PerinatSims, developed to improve technical and non-technical skills in PPH situation. This experiment hypothesized that exposure and repetition of training with PerinatSims would improve the self-assessment of non-technical skills, and therefore increase the ability to manage PPH. Methods. The primary endpoint was a self-assessment of non-technical skills during simulation session of PPH on a digital simulator. Twenty French midwives performed three of nine 25 minutes sessions of PPH screen-based simulation. Four self-assessment questionnaires were administered at the end of each simulation session: a leadership/team working questionnaire (BAT), a negative feelings/emotional questionnaire (DASS-21), a Flow questionnaire and a mental load questionnaire (NASA-TLX). Results between sessions were compared using a repeated measures ANOVA followed by a Bonferroni post hoc test. Results. The study showed a positive evolution during the three screen-based simulation sessions: an increase of leadership and team working self-assessment, an increase of Flow sense, and a decrease of negative emotions (anxiety and depression in the DASS-21 score). Significant decrease of stress was found only between the second and the third sessions, and significant differences in the NASA-TLX were observed only in two dimensions, Performance and Frustration. Conclusion. A repeated exposure to PPH situations with a screen-based simulation tool improved the midwives’ self-assessment, especially for leadership, team working, emotion management and Flow sense. Furthermore, midwives had a very positive feedback on the device. They highlighted the desire to use PerinatSims more often to be trained to PPH management, for technical as well as non-technical skills.

Effects of high-fidelity simulation education on medical students’ anxiety and confidence

“…It can be inferred that as the simulation experience accumulates, students will be able to face medical situations with more confidence and psychological stability. As previously demonstrated, repeated exposure to high-fidelity simulation experience lowered students’ negative emotions such as anxiety and depression about patient care and improved confidence in performance [ 27 , 28 ]. Research has shown that exposure to real-like virtual situations is effective in lowering anxiety and providing psychological stability [ 29 , 30 ].…”

Editorial to the April Issue

“…The first article, “Does repeated exposure to critical situations in a screen-based simulation improve the self-assessment of non-technical skills in postpartum hemorrhage management?” by Jessy Barré et al (2019), shows how the use of a medical simulation may decrease the risk of the world’s leading cause of maternal death at childbirth. This task is accomplished by training both leaders and teams to work more efficiently and empathically in such situations.…”