Surgical Management of Postpartum Hemorrhage—Building a Standardized, Validated Task Trainer

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Abstract

Faculty Advisor:

Erika Banks, MD

PURPOSE:

To develop a validated, reproducible, cost-effective task-trainer used to teach surgical management of postpartum hemorrhage.

BACKGROUND:

Postpartum hemorrhage is the third leading cause of preventable maternal death. While the use of compression and ligation sutures is infrequent, simulation teaching of skills is important.

METHODS:

Study participants (N=77) consisted of junior residents (35), senior residents (17) and faculty attending physicians (25) at a large, urban academic hospital. Pre and post- test were collected assessing prior experience, comfort, and perception regarding the model. Participants were de-identified and individually filmed performing bilateral O’Leary Stitch and B-Lynch. Two evaluators independently reviewed recordings and completed the task-specific evaluation tools, both the new untested and objective skill-assessment tool (OSAT) and previously validated Global Rating Scale (GRS). Intra-rater and inter-rater reliability were assessed, and validity was tested by comparing OSAT scores stratified by different characteristics to GRS scores.

RESULTS:

Intrarater reliability was demonstrated for both raters across each simulation and scoring tool (P<.0001). Interrater reliability for OSAT showed high agreement (Kappa 0.97 B-Lynch, 0.90 O’Leary). Construct validity was demonstrated for B-Lynch; attendings and seniors scoring higher than juniors on OSATS (17 vs. 16.7 vs. 3, P<.0001) and GRS (5 vs. 23 vs. 25, P<.0001), as well as for O’Leary simulation for both OSATS (15.5 vs. 15.0 vs. 11.0, P<.0001) and GRS (25 vs. 24 vs. 12, P<.0001).

DISCUSSION:

We have shown validation of a simple task-specific trainer that can be used to teach B-Lynch and O’Leary. The respective OSATs are reliable to assess performance.

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