Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education

Abstract

Introduction Simulation is beneficial training for low frequency high acuity events such as management of obstetric hemorrhage. Our objective was to evaluate perceived competency in management of obstetric and pelvic hemorrhage following training with low fidelity task trainers using inexpensive and common medical supplies. Materials and Methods This was a prospective observational study of training residents for management of obstetric and pelvic hemorrhage using a brief didactic instruction and low-cost task trainers with inexpensive common medical supplies. Participants practiced placement of a uterine tamponade balloon, uterine packing with gauze, pelvic parachute packing and temporary abdominal closure. Following training, participants completed a self-report survey regarding perceived competency with each technique. The Wilcoxon Signed-Rank Test was used to compare results before and after training. Results Eighteen of 23 residents completed the training and completed the survey on perceived competencies. There was a statistically significant improvement in perceived competency for all participants before and after training, with scores improving by 1.5 points for Bakri placement, from 1.94 to 3.44 (p < 0.001), improving by 1.67 points for uterine packing, from 1.78 to 3.44 (p < 0.001), improving by 1.95 for pelvic parachute packing, from 1.16 to 3.11 (p < 0.001), and improving by 1.89 for temporary abdominal closure, from 1.22 to 3.11 (p < 0.001). Conclusions Low-cost supplies and task trainers can be utilized to simulate postpartum hemorrhage and improve perceived competency in managing obstetric and pelvic hemorrhage. Similar training programs can be used in small community programs with limited resources.

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics*

“…The self-perception of the learning acquired was positive, with all respondents considering that the simulator class increased their theoretical knowledge and skills. A fact also observed in several studies, especially when the evaluation is performed by the apprentice themselves (18)(19)(20)34) . The use of simulators presents several advantages such as the possibility of repeating the procedure, correcting errors, and perceiving the difficulties (personal and inherent to the procedure) (35) .…”

“…Improvements in populational outcomes are less consistent, but there are some evidence mostly those related to neonatal outcomes (1,8,11,20) . The differences between low-and high-cost/high fidelity simulators are not established and warrants further studies (17)(18)28) .…”

“…Particularly in Obstetrics teaching, the use of simulators and simulation environments has been studied in various settings (8) , mostly obstetric emergencies such as shoulder dystocia (11)(12) , postpartum hemorrhage (13)(14)(15)(16)(17)(18) , pre-eclampsia and eclampsia (16)(17) . There is also evidence on simulation to enhance surgical skills such as suturing of vaginal and severe lacerations (19) .…”

“…Simulation environments and high-fidelity simulators, although proven to be useful, find barriers to their effective use in teaching, the main one being their cost (5,17) . With well-established learning objectives, the use of lowcost, handmade simulators can be a viable and effective alternative in the teaching and learning process (15,(17)(18)(19)(20)(21) . Thus, there are several examples of simulators handmade produced and at a reduced cost, both for teaching obstetrics (17)(18)(19)22) and other specialties/situations (23) .…”

“…With well-established learning objectives, the use of lowcost, handmade simulators can be a viable and effective alternative in the teaching and learning process (15,(17)(18)(19)(20)(21) . Thus, there are several examples of simulators handmade produced and at a reduced cost, both for teaching obstetrics (17)(18)(19)22) and other specialties/situations (23) . There is no evidence demonstrating that the hyper-reality of the simulator improves participant learning, the low cost and sometimes even the low fidelity of a simulator does not seem to represent an obstacle to its use (20)(21) .…”