Improving shoulder dystocia management among resident and attending physicians using simulations

doi:10.1016/j.ajog.2008.05.023

American Journal of Obstetrics and Gynecology

Volume 199, Issue 3, September 2008, Pages 294.e1-294.e5

Presented at the 28th Annual Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Jan. 28 through Feb. 2, 2008.

https://doi.org/10.1016/j.ajog.2008.05.023 Get rights and content

Objective

The objective of the study was to determine whether a simulation-based educational program would improve residents' and attending physicians' performance in a simulated shoulder dystocia.

Study Design

Seventy-one obstetricians participated in an unanticipated simulated shoulder dystocia, an educational debriefing session, and a subsequent shoulder dystocia simulation. Each simulation was scored, based on standardized checklists for 4 technical maneuvers and 6 communication tasks, by 2 physician observers. Paired Student t tests were used for analysis.

Results

Forty-three attendings and 28 residents participated. Residents showed significant improvement in mean maneuver (3.3 ± 0.9 vs 3.9 ± 0.4, P = .001) and communication (3.5 ± 1.2 vs 4.9 ± 1.0, P < .0001) scores after simulation training. Attending physicians' communication (3.6 ± 1.6 vs 4.9 ± 1.1, P < .0001) scores were significantly improved after training.

Conclusion

Our program improved physician performance in the management of simulated shoulder dystocia deliveries. Obstetric emergency simulation training can improve physicians' communication skills, at all levels of training, and should be incorporated into labor and delivery quality improvement measures.

Section snippets

Materials and Methods

The study group consisted of resident and full-time faculty attending physicians at a large university-based hospital that cares for a diverse population. Participation in our obstetric simulation program was strongly encouraged by departmental leadership, and accommodations were made in physicians' clinical schedules to facilitate this. Simulations were performed using a combination of human actors and a modified Noelle full-sized female anthropomorphic robotic birth simulator (Gaumard

Results

Seventy-one of a potential 86 physicians (83%) completed the study. Exclusions were due to the following: 6 never able to attend because of scheduling, 8 completed 1 simulation but unable to complete their second simulation because of scheduling, and 1 refused participation. The study population included 43 attending physicians (61%) and 28 residents (39%). Subject ages ranged from 25 to 63 years (mean ± SD: 37.0 ± 9.0 years) and 75% were female. For attending physicians in our study, years of

Comment

Shoulder dystocia is an unpredictable obstetric emergency, which requires skillfull handling in an organized manner to avoid serious maternal and neonatal sequelae. Historically, shoulder dystocia management has been taught through reading and lectures. However, the first opportunity for a trainee to utilize maneuvers is often during an actual emergency. From a patient perspective, the best person to deal with a dystocia delivery is the most experienced provider available, leaving us with the

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Shoulder dystocia
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Managing obstetric emergencies and trauma (MOET) structured skills training in Armenia, utilizing models and reality based scenarios
BMC Med Educ
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: Cite this article as: Goffman D, Heo H, Pardanani S, et al. Improving shoulder dystocia management among resident and attending physicians using simulations. Am J Obstet Gynecol 2008;199:294.e1-294.e5.

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Meeting paperSMFM paperImproving shoulder dystocia management among resident and attending physicians using simulations

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Obstet Gynecol

Shoulder dystocia

Obstet Gynecol

Clinical risk management in obstetrics: Eclampsia drills

BMJ

Recurrent obstetric management mistakes identified by simulation

Obstet Gynecol

Managing obstetric emergencies and trauma (MOET) structured skills training in Armenia, utilizing models and reality based scenarios

BMC Med Educ

Meeting paper
SMFM paper
Improving shoulder dystocia management among resident and attending physicians using simulations