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

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Faculty Advisor:

Erika Banks, MD


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


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.


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.


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).


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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