Obstetrics knowledge and skills training as a catalyst for change

Pattinson, Robert Clive; Bergh, Anne‐Marie; Makin, J.D.; Pillay, Yagan; Moodley, J; Madaj, Barbara; Ameh, Charles; Broek, Nynke van den

doi:10.7196/samj.2018.v108i9.13073

Cited by 13 publications

(26 citation statements)

References 15 publications

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“…In the last decades numerous evaluation studies on the effectiveness of simulation training in obstetric emergencies have been published, with increasing evidence that it is associated with improvement in clinical outcomes [ 13 – 32 ]. However, the results are not entirely consistent.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review published in 2003 concluded that only a few training programs in acute obstetric emergencies had been described, and even fewer had been evaluated [ 12 ]. Since this review, there have been numerous evaluation studies on the effectiveness of simulation training for obstetric emergencies, with increasing evidence that it is associated with improvement in clinical outcomes, mostly related to neonatal outcomes [ 13 – 32 ]. However, the results are not entirely consistent.…”

Section: Introductionmentioning

confidence: 99%

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Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

Tetering

Meurs

Ntuyo

et al. 2020

BMC Pregnancy Childbirth

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Background Globally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country. Methods A stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick’s classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score. Discussion This stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries. Trial registration ISRCTN98617255 , retrospectively registered July 23, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

Tetering

Meurs

Ntuyo

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…2,54,55 Regular drills both refresh clinical skills and strengthen teamwork, as has been shown in South Africa. 56 Another example, a nurse mentoring program in Karnataka, India, exemplifies the potential of regular supervision and clinical mentorship. Through six visits a year, trust improved between mentors and nurses, enabling them to introduce team-based quality improvement processes, support correct and consistent use of documentation, and improve skills in handling complications.…”

Section: Clinical Guidance Documentation and Reviewmentioning

confidence: 99%

Developing a Common Understanding of Networks of Care through a Scoping Study

Carmone

Kalaris

Leydon

et al. 2020

Health Systems & Reform

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The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multimethod scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low-and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.

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“…9 The Essential Steps in the Management of Obstetric Emergencies (ESMOE) training programme has been shown to improve the knowledge and skill sets and incorporates a list of essential skills, equipment and a pre-anaesthetic checklist. 10 These protocols should be laminated and displayed in theatre complexes. District hospitals should ideally appoint a lead anaesthetist.…”

Section: Theatre and Skills Requirementsmentioning

confidence: 99%

Anaesthesia for ruptured ectopic pregnancy at district level

Bishop

Roux

2021

S Afr Fam Pract

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In South Africa, deaths as a result of ectopic pregnancies are increasing despite the overall improvements in maternal mortality. These deaths occur predominantly in district hospitals, with the final cause of death being hypovolaemic shock in almost all cases. In most cases, no anaesthesia was attempted despite the district hospitals having the clinical skills, equipment and infrastructure to provide a caesarean delivery service. It appears that there is a skills gap between the provision of anaesthesia for caesarean delivery and that of ruptured ectopic pregnancy. There is a growing recognition of the urgent need to prioritise the provision of emergency surgical care in rural settings. This should be viewed not as a luxury but as an absolute necessity. In this study, we aim to discuss the pathophysiology of a patient with a ruptured ectopic pregnancy briefly, outline district hospital requirements for safe surgery and then discuss a simple, safe method for the provision of anaesthesia in patients deemed too unstable to transfer to a referral facility.

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Obstetrics knowledge and skills training as a catalyst for change

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 13 publications

References 15 publications

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

Developing a Common Understanding of Networks of Care through a Scoping Study

Anaesthesia for ruptured ectopic pregnancy at district level

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