Shoulder Dystocia Simulation Training Improves Attending Physician Communication and Technical Skills [32M]

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Abstract

INTRODUCTION:

Simulation has been widely adopted for resident training. The purpose of this study was to determine if an innovative shoulder dystocia simulation training program for attending physicians can improve performance.

METHODS:

Five academic medical centers with the same malpractice insurance company mandated all attending physicians to complete standardized simulation training for the management of shoulder dystocia. Baseline and post-training performance of communication and technical skills were compared in the simulated environment.

RESULTS:

288 attending physicians completed simulation training between 4/1/2016-6/22/2017. Most participants were female (69%) and had >11 years of experience (63%). Improvements in provider communication were noted in the following areas: Instructs patient (52.6% to 77.9%, P<0.001), provides explanation (49.1% to 84.2%, P<0.0001), notes time (26.7% to 47%, P<0.0001), requests rapid response (81.2% to 97%, P>0.0001), and calls for: Nursing (72.6% to 92.6%, P<0.0001), Pediatrics (70.5% to 93.7%, P<0.0001), Second OB (73.3% to 92.6%, P<0.0001), and Anesthesia (64.9% to 92.3%, P<0.0001). Provider performance of maneuvers were also noted to improve: McRobert's (93.7% to 97.5% P=0.0266), suprapubic pressure (63.2% to 93.9%, P<0.0001), rotational maneuvers (71.5% to 90.5%, P<0.0001), and posterior arm delivery (59.6% to 89.4%, P<0.0001). Significant improvements were also seen with the trainer's overall assessment of the provider's management of the emergency (66% to 95.1% P<0.0001).

CONCLUSION:

A simulation program for shoulder dystocia can improve attending performance in caring for this infrequent obstetric emergency. What remains to be demonstrated is whether this will translate into improved patient outcomes.

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