Maslovitz Sharon, Barkai Gad, Lessing Joseph B, Ziv Amitai, Many Ariel
Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Obstet Gynecol. 2007 Jun;109(6):1295-300. doi: 10.1097/01.AOG.0000265208.16659.c9.
To develop a simulation-based curricular unit for labor and delivery teams involved in obstetric emergencies to detect and address common mistakes.
A simulation-based curricular unit for hands-on training of four obstetric emergency scenarios was developed using high-tech mannequins and low-tech simulators. The scenarios were eclamptic seizure, postpartum hemorrhage, shoulder dystocia, and breech extraction. The obstetric teams consisted of at least one resident and two midwives. Checklists of actions expected from the teams were handed out to the course's tutors who observed the "event." All sessions were videotaped and then reviewed and analyzed by the trainees themselves, who were guided by two experienced tutors. We identified the most commonly occurring mistakes by summing up checklists and by watching the recorded sessions.
Between February 2004 and April 2006, 60 residents in obstetrics and gynecology and 88 midwives underwent the simulation-based course. Forty-two labor and delivery teams completed all four sessions. The most common management errors were delay in transporting the bleeding patient to the operating room (82%), unfamiliarity with prostaglandin administration to reverse uterine atony (82%), poor cardiopulmonary resuscitation techniques (80%), inadequate documentation of shoulder dystocia (80%), delayed administration of blood products to reverse consumption coagulopathy (66%), and inappropriate avoidance of episiotomy in shoulder dystocia and breech extraction (32%). Eighteen trainees were invited for repeated sessions at least 6 months after the first training day, and their scores were significantly higher in the latter sessions (79.4+/-4.3 versus 70+/-5.3 for the second and first simulated eclampsia sessions).
A curricular unit based on simulation of obstetric emergencies can identify pitfalls of management in labor and delivery rooms that need to be addressed.
为参与产科急症处理的分娩团队开发一个基于模拟的课程单元，以发现并纠正常见错误。
利用高科技人体模型和低技术模拟器，开发了一个针对四种产科急症场景进行实践培训的基于模拟的课程单元。这些场景包括子痫发作、产后出血、肩难产和臀位牵引。产科团队至少由一名住院医师和两名助产士组成。向观察“事件”的课程导师发放团队预期行动清单。所有课程均进行录像，然后由学员在两名经验丰富的导师指导下自行观看、回顾和分析。我们通过汇总清单和观看录像课程来确定最常出现的错误。
在2004年2月至2006年4月期间，60名妇产科住院医师和88名助产士参加了基于模拟的课程。42个分娩团队完成了所有四个课程。最常见的管理错误包括：将出血患者送往手术室延迟（82%）、不熟悉使用前列腺素治疗宫缩乏力（82%）、心肺复苏技术差（80%）、肩难产记录不充分（80%）、延迟输注血液制品治疗消耗性凝血病（66%）以及在肩难产和臀位牵引时不适当避免会阴切开术（32%）。18名学员在首次培训日至少6个月后被邀请参加重复课程，他们在后一次课程中的得分显著更高（第二次和第一次模拟子痫发作课程的得分分别为79.4±4.3和70±5.3）。
一个基于产科急症模拟的课程单元能够识别产房管理中需要解决的问题。
