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Training and assessment in obstetrics: the role of simulation

https://doi.org/10.1016/j.bpobgyn.2010.03.003Get rights and content

Simulation is becoming an integral part of the training and assessment of obstetricians. Given the variety of manual skills that must be learned, awake patients and high-risk environment, obstetrics is uniquely suited for simulation. Simulation provides opportunities to rehearse and learn from mistakes without risks to patients. The use of simulation can help overcome some limitations of the current medical education and practice environment, including work-hour limitations and concerns for patient safety. Both low- and high-fidelity simulation models can be used to accomplish educational goals. Basic and advanced skills as well as the management of obstetric emergencies are amenable to simulation. For a simulation programme to be successful, one must identify the learner and the skills that are to be learned. In the future, simulation will be more available and realistic and will be used not only for education, but also for ongoing assessment of providers.

Section snippets

Initial learning of skills

Medical training has long relied on the apprenticeship model. This is a logical and effective way to learn; however, in the context of learning medical care, it does not completely obviate the risk of harm to patients. Even though learners are initially supervised during their first patient encounters, their hands are on the patient and their actions may cause injury before the teacher could intervene.

Simulation allows learners to practise new hands-on skills in an environment that puts no

Maintenance of skills

Medical professionals learn innumerable skills during their training, and as a specific vocation is chosen, the breadth of skills is narrowed, but the required depth of knowledge and proficiency increases. Certain skills are performed on such a regular basis, such as a routine spontaneous vaginal delivery, that habit and muscle memory take over and little thought is needed to perform the task correctly and safely. Other skills, such as managing a shoulder dystocia, occur infrequently enough

Testing and demonstration of proficiency

As discussed above, certain skills are performed so often that a new learner can be observed a sufficient number of times to ensure their proficiency. For rare events, a trainee might be exposed to such a small number of events that is not possible to certify them as competent. Simulation can provide a platform for teaching and testing in these settings.

For early learners, such as medical students, simulation can play a role in testing performance of basic skills. American medical schools have

What types of simulators are available for obstetrics?

For many years, a doll and bony pelvis have been used to teach the cardinal movements of labour and delivery. From this simple concept, groups have developed more complex models and commercial products.

Simulation models are often classified by their resemblance, or fidelity, to the actual patient and event that they are trying to reproduce. Models are typically classified as either low or high fidelity. Low-fidelity models, such as the pelvis and doll described above, are typically simple,

Where should simulation for obstetrics take place?

The location used for simulation training will vary based on what is available at each institution. Within a given institution, simulation sessions may be held at different sites based on who the learner is and what you want them to learn. By conducting simulation sessions in clinical areas, such as the labour and delivery suite, operating rooms or prenatal ultrasound unit, learners are better able to become immersed in the scenario and have access to equipment, medications and personnel that

What can be simulated in obstetrics?

The list of obstetric skills and emergencies that can be simulated is extensive. Publications related to simulation in obstetrics typically fall into three categories:

  • 1.

    description of a simulation model/drill only;

  • 2.

    description of a model/drill with comparison of learner performance before and after simulation (immediately or at a later date); and

  • 3.

    description of one or more simulation models/drills incorporated into a multi-faceted and/or multidisciplinary and/or teamwork training programme.

The

What are the key components of a simulation programme?

Unfortunately, many institutions have spent large sums of money on simulation equipment before developing their simulation programme. The birth simulator, no matter how sophisticated, does not run itself; an individual, or team, needs to support its operation. Perhaps more important than the simulation equipment is the creation of the simulation programme or curriculum. As with any curriculum development, the educator must determine several factors to create a simulation programme that will be

What are the limitations and challenges of simulating obstetrics?

The initial challenge to using simulation for training and assessment in obstetrics is using the correct approach to developing the programme. Starting small is best so as not to waste time and resources. Another challenge to any simulation model specifically, and a simulation programme as a whole, is getting learners to become involved. Learners may initially be unwilling to suspend their disbelief and engage in a scenario, or not fully participate, out of fear of failure or embarrassment.

What is the future of simulation for training and assessment in obstetrics?

The current environment for trainees, with an emphasis on patient safety, reduced clinical caseload and limited work hours, will not likely improve in the future. Despite these limitations, providers still need to become competent in basic skills. Simulation can be used to address these factors. Programmes are likely to grow at the local level. Governmental, educational and certification entities may consider supporting stand-alone simulation centres to provide sufficient training

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