A pilot study on the simulation-based training for Ethiopia skilled birth attendants.

This simulation-based Ethiopia Midwife Train-the-Trainer program for skilled birth attendants is one part of the China-UK Global Health Support Program (GHSP) activities and an approach to improving the Ethiopia trainers' midwifery teaching skills. This pilot study aimed to evaluate the effectiveness of a simulation-based training for Ethiopia skilled birth attendants. This program was divided into three stages. In Stage 1, Fudan team trained 5 trainers from Ethiopia. In Stage 2, Fudan team supervised and evaluated the 1st stage Ethiopia trainers to train their peers becoming the trainers in Fudan University. In Stage 3, Fudan team evaluated the training program implementation in established Advanced Midwifery Practice Center in Tirunesh Beijing General Hospital. The participatory observational method was used for process evaluation and the Kirkpatrick model was used for effectiveness evaluation. The Ethiopia staff's teaching skills for simulation-based midwifery training were strengthened and their abilities to deal with various complicated obstetric situations were improved by group explanation, questions, rehearsal, and step-by-step interactive teaching (p < .01). The mean score of total mastery degree was 3.48 ±â€¯0.16 by self-assessment and 3.63 ±â€¯0.16 by peer-assessment in stage 2, and 3.27 ±â€¯0.24 by self-assessment and 3.38 ±â€¯0.34 by peer-assessment in stage 3.The GHSP-OP4-V01 Ethiopia Midwife Train-the-Trainer Program has received positive response in Ethiopia by in-depth interview and questionnaire survey. This study demonstrated that the simulation-based training is an effective approach for midwifery Train-the-Trainer program in Ethiopia.

Effect of episiotomy training with beef tongue and sponge simulators on the self-confidence building of midwifery students.

This study assesses the efficacy of simulation-based episiotomy training (SBET) with beef tongue and sponge models in terms of the self confidence of midwifery students while performing episiotomy. Third-year midwifery students from Cumhuriyet University in the fall semesters of 2011 and 2012 were enrolled in the sponge and beef tongue model groups (n = 36 and n = 37, respectively). A checklist was prepared on the required skills for performing episiotomy which can be broken into three main parts, namely preparation, cutting and repairing and completion. According to the checklist, a Likert type questionnaire was developed including 5 items for preparation, 11 items for cutting and repairing, and 6 items for completion. After SBET with the sponge and beef tongue models in our laboratories of Midwifery Department, the students performed episiotomy steps in laboring women in Sivas State Hospital and then they filled in the questionnaire to indicate whether they gained self-confidence in performing episiotomy or not. Although, participants of both groups have successfully completed all the steps of episiotomy, overall, beef tongue model was found to be more successful regarding their self-confidence (p < 0.05), including the skills in performing local anesthesia; choosing needle holder, suture material and scissor for cutting; identifying apex, hymen and skin; using needle holder properly while penetrating into the skin, suturing vaginal mucosa until hymen, knotting, and suturing perineal muscles and skin. Our results suggest that while SBET with both models are applicable for episiotomy training of midwifery students in the laboratory setting, SBET with beef tongue model provides an additional increase in their self-confidence in the clinical settings.

Clinical performance and patient outcome after simulation-based training in prevention and management of postpartum haemorrhage: an educational intervention study in a low-resource setting.

BACKGROUND: Postpartum haemorrhage (PPH) is a major cause of maternal mortality. Prevention and adequate treatment are therefore important. However, most births in low-resource settings are not attended by skilled providers, and knowledge and skills of healthcare workers that are available are low. Simulation-based training effectively improves knowledge and simulated skills, but the effectiveness of training on clinical behaviour and patient outcome is not yet fully understood. The aim of this study was to assess the effect of obstetric simulation-based training on the incidence of PPH and clinical performance of basic delivery skills and management of PPH. METHODS: A prospective educational intervention study was performed in a rural referral hospital in Tanzania. Sixteen research assistants observed all births with a gestational age of more than 28 weeks from May 2011 to June 2013. In March 2012 a half-day obstetric simulation-based training in management of PPH was introduced. Observations before and after training were compared. The main outcome measures were incidence of PPH (500-1000 ml and >1000 ml), use and timing of administration of uterotonic drugs, removal of placenta by controlled cord traction, uterine massage, examination of the placenta, management of PPH (>500 ml), and maternal and neonatal mortality at 24 h. RESULTS: Three thousand six hundred twenty two births before and 5824 births after intervention were included. The incidence of PPH (500-1000 ml) significantly reduced from 2.1% to 1.3% after training (effect size Cohen's d = 0.07). The proportion of women that received oxytocin (87.8%), removal of placenta by controlled cord traction (96.5%), and uterine massage after birth (93.0%) significantly increased after training (to 91.7%, 98.8%, 99.0% respectively). The proportion of women who received oxytocin as part of management of PPH increased significantly (before training 43.0%, after training 61.2%). Other skills in management of PPH improved (uterine massage, examination of birth canal, bimanual uterine compression), but these were not statistically significant. CONCLUSIONS: The introduction of obstetric simulation-based training was associated with a 38% reduction in incidence of PPH and improved clinical performance of basic delivery skills and management of PPH.

The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings.

OBJECTIVES: The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. METHODS: Twenty midwives completed a simulation-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established validity evidence, and they advanced to the next level only after attaining predefined levels of performance. The number of repetitions and time needed to achieve predefined performance levels were recorded along with the performance scores in each setting. Finally, the outcomes were correlated across settings. RESULTS: A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P < .001). Performance scores on the VR simulator correlated well to the clinical performance scores (Pearson correlation coefficient .81; P = .049). No significant correlations were found between numbers of attempts needed to reach proficiency across the 3 different settings. A post hoc analysis found that the 50% fastest trainees at reaching proficiency during simulation-based training received higher clinical performance scores compared to trainees with scores placing them among the 50% slowest (P = .025). CONCLUSIONS: Performances during simulation-based sonography training may predict performance in related tasks and subsequent clinical learning curves.