Comeau Robyn, Craig Catherine
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.
J Obstet Gynaecol Can. 2014 Mar;36(3):258-265. doi: 10.1016/S1701-2163(15)30635-6.
Documentation of deliveries complicated by shoulder dystocia is a valuable communication skill necessary for residents to attain during residency training. Our objective was to determine whether the teaching of documentation of shoulder dystocia in a simulation environment would translate to improved documentation of the event in an actual clinical situation.
We conducted a cohort study involving obstetrics and gynaecology residents in years 2 to 5 between November 2010 and December 2012. Each resident participated in a shoulder dystocia simulation teaching session and was asked to write a delivery note immediately afterwards. They were given feedback regarding their performance of the delivery and their documentation of the events. Following this, dictated records of shoulder dystocia deliveries immediately before and after the simulation session were identified through the Meditech system. An itemized checklist was used to assess the quality of residents' dictated documentation before and after the simulation session.
All eligible residents (18) enrolled in the study, and 17 met the inclusion criteria. For 10 residents (59%) documentation of a delivery with shoulder dystocia was present before and after the simulation session, for five residents (29%) it was only present before the session, and for two residents (18%) it was only present after the session. When residents were assessed as a group, there were no differences in the proportion of residents recording items on the checklist before and after the simulation session (P > 0.05 for all). Similarly, analysis of the performance of the10 residents who had dictated documentation both before and after the session showed no differences in the number of elements recorded on dictations done before and after the simulation session (P > 0.05 for all).
The teaching of shoulder dystocia documentation through simulation did not result in a measurable improvement in the quality of documentation of shoulder dystocia in actual clinical situations.
记录并发肩难产的分娩情况是住院医师在住院医师培训期间必须掌握的一项重要沟通技能。我们的目的是确定在模拟环境中进行肩难产记录教学是否会转化为在实际临床情况下对该事件记录的改善。
我们进行了一项队列研究，研究对象为2010年11月至2012年12月期间的二至五年级妇产科住院医师。每位住院医师参加一次肩难产模拟教学课程，并被要求在课后立即撰写一份分娩记录。他们收到了关于其分娩表现和事件记录的反馈。在此之后，通过Meditech系统识别模拟课程前后立即发生的肩难产分娩的口述记录。使用一份详细的清单来评估模拟课程前后住院医师口述记录的质量。
所有符合条件的18名住院医师均纳入研究，其中17名符合纳入标准。对于10名住院医师（59%），模拟课程前后均有并发肩难产分娩的记录；对于5名住院医师（29%），仅在课程前有记录；对于2名住院医师（18%），仅在课程后有记录。当将住院医师作为一个整体进行评估时，模拟课程前后记录清单上各项内容的住院医师比例没有差异（所有P>0.05）。同样，对在课程前后都有口述记录的10名住院医师的表现进行分析，结果显示模拟课程前后口述记录中记录的要素数量没有差异（所有P>0.05）。
通过模拟进行肩难产记录教学并未导致实际临床情况下肩难产记录质量有可测量的改善。
