Postpartum hemorrhage is the leading cause of maternal mortality and requires preparation and rapid response from medical teams. Simulation-based training has been shown to improve learner competency in evaluating and treating obstetrical emergencies. The objective of this study was to determine the effectiveness of repeated simulation in improving knowledge, performance, confidence and reaction time of providers during a postpartum hemorrhage.
During a 1 year period, small group sessions were conducted with obstetrics and gynecology residents including a didactic session followed by a simulation drill. Pre and post-testing were performed using validated knowledge tests, performance checklists, and confidence surveys. The sessions were repeated with the same residents at 3 month intervals. Outcomes were measured comparing test scores, confidence surveys and time to operating room transfer. Paired t tests and repeated measures of analyses were used for statistical analysis.
Six residents participated in 3-month interval training sessions. Mean pre-post knowledge test scores significantly increased (73.33%, 91.67%, P<.01). Assessment and management of postpartum hemorrhage significantly improved as demonstrated by pre-post performance tests (45.32%, 76.57%, P<.01). Mean decision time to operating room transfer significantly increased (6.15 min, 3.33 min, P<.01). Resident surveys indicated that confidence in managing a postpartum hemorrhage had significantly improved as a result of the simulation-based sessions (2.29, 3.88, P<.01, 1=low, 5=high).
Repeated interval simulation-based training of postpartum hemorrhage management improves performance and retention of skills for providers who may be faced with these rare but life-threatening obstetrical emergencies.
Inova Health System, Falls Church, VA
Financial Disclosure: The authors did not report any potential conflicts of interest.