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

Abstract

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.

Effectivity of Hands-on Near-peer teaching in Scientific Writing for Indian Medical Students

“…Orientation of participants was conducted with the administration of research motivation scale (adopted & modi ed from Situation Motivation Scale) on Day 1. 29 Each manuscript was evaluated by 2 faculty researchers with prior expertise in the particular type of scienti c writing in a double-blinded manner using manuscript evaluation scales [30][31][32][33][34][35] (Table 2A, Table 2B)…”

“…As per Kirkpatrick's model for evaluating the e cacy of a training program, the participants were assessed on the basis of their research motivation (level 1: to gauge reactions), test scores (level 2: to evaluate learning), and manuscripts (level 3: to assess behavior). 29 This was achieved by using the following tools: a. Research motivation: The form was adapted from the Situational Motivation Scale 29 so that the questions mapped amotivation (AM), intrinsic motivation (IM), extrinsic motivation (EM), identi ed regulation (IR), and participant's attitude (A) with respect to research.…”

“…45,46 The learning outcomes at the rst three levels of the Kirkpatrick model for evaluating the e cacy of the learning initiative were obtained by assessing the research motivation, the test scores, and evaluating the writing assignments. 29 The pre-and post-workshop manuscripts prepared were assessed by two independent external reviewers in a double-blind format. Even though the reviewers were unaware of whether a given manuscript was written pre-or post-workshop, a signi cant increase was noted in the scores received in the post-workshop manuscripts of all scienti c writing types except case reports and perspective/commentaries.…”

Simulation training on respectful emergency obstetric and neonatal care in north-western Madagascar: a mixed-methods evaluation of an innovative training program

“…The first phase was the training of trainers (TOT) session, held via Zoom in June 2021 for ten trainers native to Madagascar and selected by the MOH. The TOT course introduced simulation as a pedagogical methodology, including how to conduct pre- and post-briefing processes [ 5 , 8 , 27 , 28 ]. It also included reviews of national guidelines on the six topics and best practices for emergency care.…”

“…Simulation is particularly useful when preparing healthcare workers to provide emergency care, when teams must operate rapidly, smoothly, and cooperatively in those situations to provide high-quality life-saving patient care. Simulation is therefore highly relevant when training providers to attend to women during childbirth [ 6 – 8 ].…”