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.