Improving shoulder dystocia management among resident and attending physicians using simulations

• Published in: American journal of obstetrics and gynecology Vol. 199; no. 3; pp. 294.e1 - 294.e5
• Main Authors: Goffman, Dena, MD, Heo, Hye, MD, Pardanani, Setul, MD, Merkatz, Irwin R., MD, Bernstein, Peter S., MD, MPH
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-09-2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Clinical Competence; Delivery, Obstetric - education; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Dystocia - therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Internship and Residency; Medical sciences; Medical Staff, Hospital; obstetric birth simulator; Obstetrics - education; Obstetrics and Gynecology; Pregnancy; Pregnancy. Fetus. Placenta; Shoulder; shoulder dystocia simulation; shoulder dystocia simulation; obstetric birth simulator; Clinical management; Treatment; Pregnancy disorders; Simulation; Shoulder; Gynecology; Dystocia; Physician; Delivery disorders; Resident; Obstetrics
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2008.05.023

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.