Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, ON.
Department of Obstetrics and Gynecology, St Joseph's Healthcare Hamilton, Hamilton, ON.
J Obstet Gynaecol Can. 2020 Jul;42(7):868-873.e1. doi: 10.1016/j.jogc.2019.12.011. Epub 2020 Mar 11.
Simulation is increasingly valued as a learning tool in obstetrical practice. In situ simulation assesses the hands-on and critical thinking skills of a health care team within their clinical setting. We aimed to create an in situ simulation program to promote skills acquisition, enhance teamwork, and identify system limitations.
Key obstetrical emergencies were identified through a needs assessment. In situ simulations were developed to address these clinical presentations. During simulations, organizers and participants identified latent safety threats. Medical management was evaluated through comprehensive emergency-specific checklists. Leadership attitudes were assessed using the modified Perinatal Emergency Team Response Assessment tool. Following each simulation, team members were debriefed, and qualitative and quantitative feedback was solicited and aggregated by specialty and discipline.
Simulations were conducted monthly at two academic centers over 14 months. Participation was interdisciplinary, including learners, staff physicians, nursing, and allied health team members from the departments of obstetrics, anesthesia, emergency medicine, and neonatology. Participants reported their involvement was enjoyable. Participants reported improvements in communication skills, content knowledge, and procedural knowledge. Participants favourably rated the spontaneity of simulations, clinically relevant scenarios, safe environment, and use of realistic equipment. Latent safety threats, related to equipment, medication, personnel, resources, and technical skills, were identified.
We present the successful implementation of a comprehensive in situ simulation program. In situ simulation allows for deliberate practice of obstetrical emergencies and promotes a culture of patient safety. Lessons learned provide valuable data to identify limitations within our current practices and inform future policy change.
模拟在产科实践中越来越被视为一种学习工具。现场模拟评估医疗保健团队在其临床环境中的实际操作和批判性思维技能。我们旨在创建一个现场模拟计划，以促进技能获取，增强团队合作，并确定系统限制。
通过需求评估确定了关键的产科急症。现场模拟针对这些临床表现进行了开发。在模拟过程中，组织者和参与者确定了潜在的安全威胁。通过综合紧急情况特定清单评估医疗管理。使用改良的围产期应急小组反应评估工具评估领导态度。每次模拟后，团队成员进行了汇报，根据专业和学科收集和汇总了定性和定量反馈。
在 14 个月的时间里，在两个学术中心每月进行一次模拟。参与者包括来自妇产科、麻醉科、急诊医学科和新生儿科的学习者、工作人员医生、护理和联合医疗团队成员，具有跨学科性。参与者表示他们的参与很愉快。参与者报告说，他们的沟通技巧、内容知识和程序知识都有所提高。参与者对模拟的自发性、临床相关场景、安全环境以及使用真实设备给予了高度评价。确定了与设备、药物、人员、资源和技术技能相关的潜在安全威胁。
我们成功实施了一项全面的现场模拟计划。现场模拟允许对产科急症进行有针对性的实践，并促进患者安全文化。经验教训提供了有价值的数据，可用于确定我们当前实践中的局限性，并为未来的政策变更提供信息。
