Introduction: One of the most significant contributors to neonatal morbidity and mortality is preterm labor and subsequent delivery. For any obstetric provider, this is among the most important diagnostic and management skills to develop quickly so as to minimize the potential for harm to the infant. Proper recognition, interpretation, and management of maternal symptoms, clinical findings, and fetal heart rate tracing are critical skills for the obstetric trainee. This education is traditionally acquired through exposure to lectures, independent study, and case discussion, as well as hands-on clinical experience of labor and delivery. This simulation provides tools to teach medical and nursing students to recognize and develop a management plan for a patient at risk of preterm birth. Methods: The student is expected to review in advance either the online didactic session, a summary paper, or both. Reference materials are also provided for students desiring more detailed preparation. During the simulation, the student evaluates and manages preterm birth in a high-fidelity mannequin. The student is unaware of the patient’s diagnosis without performing an appropriate history and physical. Immediately after the simulation, the student documents the encounter, and a formal debriefing session is held. Whenever possible, video recordings of the simulations should be made to assist with the debriefing of trainees’ technical and communication skills. Advance preparation requires 20-30 minutes, the simulation takes 5-15 minutes, and the debriefing lasts 15-30 minutes. Results: The implementation of this curriculum has provided us with the information necessary to educate and train a range of obstetric providers in the evaluation and management of preterm labor using a high-fidelity pregnancy and delivery simulator. Discussion: The advent of high-fidelity simulators makes the lifelike simulation of obstetric emergencies such as premature labor possible. The experience allows realistic diagnosis and management in a setting that does not put patients at risk. We believe that the competencies acquired from this training curriculum will generalize to other obstetric emergency care settings.
- Experienced a scenario involving the management of preterm labor in a simulated setting.
- Become more skilled in interacting with nursing staff and a simulated patient in a stressful simulated setting.
- Reviewed the video-recorded simulation session with the instructor and identified areas for improvement relating to technical and communication skills.
- American College of Obstetricians and Gynecologists, Committee on Practice Bulletins—Obstetrics. Practice bulletin 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011;117:1472-1483. http://dx.doi.org/10.1097/AOG.0b013e3182238c31
- American College of Obstetricians and Gynecologists, Committee on Practice Bulletins—Obstetrics. Practice bulletin 127: Management of preterm labor. Obstet Gynecol. 2012;119(6):1308-1317. http://dx.doi.org/10.1097/AOG.0b013e31825af2f0
- Arafeh JM, Hansen SS, Nichols A. Debriefing in simulated-based learning: facilitating a reflective discussion. J Perinat Neonatal Nurs. 2010;24(4):302-311. http://dx.doi.org/10.1097/JPN.0b013e3181f6b5ec
- Deering SH, Hodor JG, Wylen M, Poggi S, Nielsen PE, Satin AJ. Additional training with an obstetric simulator improves medical student comfort with basic procedures. Simul Healthc. 2006;1(1):32-34. http://dx.doi.org/10.1097/01266021-200600110-00003
- Deering S, Rosen MA, Salas E, King HB. Building team and technical competency for obstetric emergencies: the mobile obstetric emergencies simulator (MOES) system. Simul Healthc. 2009;4(3):166-173. http://dx.doi.org/10.1097/SIH.0b013e31819aaf2a
- Massachusetts Coalition for the Prevention of Medical Errors. When Things Go Wrong: Responding to Adverse Events. Burlington, MA: Massachusetts Coalition for the Prevention of Medical Errors; 2006. http://www.macoalition.org/publications.shtml.
- Miller MS, Shannon KM, Wetzel GT. Neonatal bradycardia. Prog Pediatr Cardiol. 2000;11(1):19-24. http://dx.doi.org/10.1016/S1058-9813(00)00032-1
- NICHD Neonatal Research Network. Extremely preterm birth outcome data [calculator for extremely preterm infants]. http://www.nichd.nih.gov/about/org/der/branches/ppb/programs/epbo/pages/epbo_case.aspx. Published November 30, 2012.
- Pehrson C, Sorensen J, Amer-Wahlin I. Evaluation and impact of cardiotocography training programmes: a systematic review. BJOG. 2011;118(8):926-935. http://dx.doi.org/10.1111/j.1471-0528.2011.03021.x
- Pliego JF, Wehbe-Janek H, Rajab MH, Browning JL, Fothergill RE. OB/GYN boot camp using high-fidelity human simulators: enhancing residents' perceived competency, confidence in taking a leadership role, and stress hardiness. Simul Healthc. 2008;3(2):82-89. http://dx.doi.org/10.1097/SIH.0b013e3181658188
- Salas E, Klein C, King H, et al. Debriefing medical teams: 12 evidence-based best practices and tips. Jt Comm J Qual Patient Saf. 2008;34(9):518-527.
- Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. The effectiveness of video-assisted debriefing versus oral debriefing alone at improving neonatal resuscitation performance: a randomized trial. Simul Healthc. 2012;7(4):213-221. http://dx.doi.org/10.1097/SIH.0b013e3182578eae
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