Perceived value of basic interprofessional simulation training in obstetrics: what do the participants think?

Introduction

There is increasing evidence of the value of multidisciplinary simulation training in obstetrics.¹ Various aspects of simulation training have been reported including effects on knowledge, skills, team working and patient outcomes.² However, there is little literature on the perceptions of participants themselves about simulation and its effects on their self-confidence.

Training should be tailored to the participants³ but this can be challenging if the group is heterogeneous, as was encountered at Sidra Medicine, Qatar. Sidra Medicine is a 400-bedded tertiary care hospital, which opened to obstetric inpatient services in 2018. The multidisciplinary obstetric staff cohort is culturally diverse comprising individuals of over 90 different nationalities. A ‘first response’ simulation programme was commenced to train staff in mobilising the emergency team and materials required for initial care and management.

This survey-based study was carried out to evaluate staff perceptions of simulation training and compare participant confidence before and after attending the simulation-based learning programme. The results of this study are being used to inform the development of a standardised simulation training approach and curriculum for this unique recipient group.

Methods

This study was deemed exempt from ethical approval and approved by departmental leads.

An anonymised electronic survey was sent out to all obstetric clinical staff in July 2018, prior to participation in simulation training. Questions in the survey (see the online supplementary appendix 1) related to the participants’ clinical role and experience and confidence in dealing with common obstetric emergencies. Participants’ opinions around the delivery of simulation training, including purpose, setting, format and dedicated time for the training were also assessed.

The clinical staff then underwent a 3-month programme of multidisciplinary ‘first response simulations’ following which, the survey was then sent out again to assess the impact of the programme on staff attitudes and confidence.

Data from the two surveys were analysed using SPSS (V.23.0). Descriptive statistics were computed and comparisons in mean survey question scores presimulation and postsimulation training were calculated using the Student t-test.

Results

A total of 150 staff completed the first survey of which 30% were midwives, 60% nurses and the remaining other healthcare staff. The149 postsimulation respondents comprised 52% midwives, 35% nurses and 10% others. Eighty per cent of the postsimulation group had ≥5 years of obstetric experience compared with 60% in the presimulation group.

Statistically significant differences in mean presimulation and postsimulation survey scores for participants’ confidence in the management of six obstetric emergency scenarios practised during the simulation training sessions were demonstrated (see the online supplementary appendix 2). Eighty-five per cent of presimulation participants were confident they knew their role in an emergency with clarity versus 93% postsimulation.

When asked about the role of simulation training, a majority of the participants in both groups agreed that simulation was valuable in improving teamwork, communication and practical skills and that it was a good way of learning emergency skills. However, postsurvey respondents were less likely to feel that the simulation exercises improved clinical knowledge after the programme was completed (92% vs 84%).

There was no change in how the majority felt simulation should be scheduled with around 70% preferring scheduled simulation sessions and 30% ad hoc surprise drills. No differences were seen between the two groups in terms of the amount of time dedicated to ward based teaching per week, with around 50% feeling that 1–2 hours would be adequate.

Discussion

The main findings of the study so far are that a diverse group of participants understood the role of simulation and that simulation improved the participants’ confidence in dealing with emergencies as discussed below.

The role of good quality simulation is an improvement in knowledge of obstetric management,¹ teamworking,² communication and team performance.¹ We have confirmed that the majority of our participants’ views were in line with these findings.

The important finding of the survey was the participants’ significantly increased self-perception of confidence in managing common obstetric emergencies after participating in the simulation training programme. Research links an improvement in confidence to an improvement in performance,⁴ which, in this context, could potentially lead to improved clinical outcomes. Therefore, improved confidence could be a significant benefit of simulation and could have the potential to be an indirect predictor of performance. Stöerr et al’s⁵ survey-based study of simulation in obstetrics demonstrated an increase in the participants’ clarity of their role in emergencies and in their ability to get appropriate help after training. The findings of our study are congruent with these results.

The findings demonstrated that simulation had not achieved a significant increase in staff confidence in arranging emergency patient transfers (70.9% after simulation vs 67.6% before simulation). This could have been influenced by issues with changing the availability of services due to phased activation of the hospital.

With regard to participant’s views on the delivery of training, it is important to consider that for Sidra Medicine, the combination of high staffing levels, phased activation and initial low patient numbers meant that scheduled intensive daily sessions were possible. The views of the participants about the frequency and dedicated time for simulation may therefore have been influenced by their experience of this intense intervention and also by their own assessment of requirements of the unit on activation of services.

Limitations

This study is based mainly on results from self-reported outcomes that is, self-reported participant confidence in dealing with scenarios. Therefore, the results can be subject to conscious and unconscious bias.

Conclusion and future plans

As part of hospital activation, simulation training was made to focus on the ‘first response’ aspect of each obstetric scenario. Progress to the full obstetric simulation then followed the initial 3-month programme and continues with regular sessions. The results from this study are now being used to modify and refine the delivery of the ongoing simulation programme at Sidra Medicine. There are plans to further study recipient perceptions of simulation training after the modified simulation programme has been completed.

In conclusion, these results from the ongoing study confirm that the simulation programme we used improved staff confidence in dealing with common obstetric emergencies. The findings serve to highlight the ever-increasing scope of simulation training in obstetrics.