van Tetering Anne Antonia Cornelia, Segers Maartje Henrica Martine, Ntuyo Peter, Namagambe Imelda, van der Hout-van der Jagt M Beatrijs, Byamugisha Josaphat K, Oei S Guid
Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands.
Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda.
JMIR Med Educ. 2021 Feb 5;7(1):e17277. doi: 10.2196/17277.
Simulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick's theoretical model. The results on the Kirkpatrick levels are closely related to the quality of the instructional design of a training program. The instructional design is generally defined as the "set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes."
The aim of this study is to evaluate the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country.
A stepped-wedge cluster randomized trial was performed in a university hospital in Kampala, Uganda, with an annual delivery volume of over 31,000. In November 2014, a medical simulation center was installed with a full-body birthing simulator (Noelle S550, Gaumard Scientific), an interactive neonate (Simon S102 Newborn CPR Simulator, Gaumard Scientific), and an audio and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainers. From 2014 to 2016, training was provided to 57 residents in groups of 6 to 9 students. Descriptive statistics were calculated for ten instructional design features of the training course measured by the 42-item ID-SIM (Instructional Design of a Simulation Improved by Monitoring). The Wilcoxon signed rank test was conducted to investigate the differences in scores on knowledge, the Clinical Teamwork Scale, and medical technical skills.
The mean scores on the ten instructional design features ranged from 54.9 (95% CI 48.5-61.3) to 84.3 (95% CI 80.9-87.6) out of 100. The highest mean score was given on the feature feedback and the lowest scores on repetitive practice and controlled environment. The overall score for the training day was 92.8 out of 100 (95% CI 89.5-96.1). Knowledge improved significantly, with a test score of 63.4% (95% CI 60.7-66.1) before and 78.9% (95% CI 76.8-81.1) after the training (P<.001). The overall score on the 10-point Clinical Teamwork Scale was 6.0 (95% CI 4.4-7.6) before and 5.9 (95% CI 4.5-7.2) after the training (P=.78). Medical technical skills were scored at 55.5% (95% CI 47.2-63.8) before and 65.6% (95% CI 56.5-74.7) after training (P=.08).
Most instructional design features of a technology-enhanced simulation-based training in obstetrics in a low-income country were scored high, although intervals were large. The overall score for the training day was high, and knowledge did improve after the training program, but no changes in teamwork and (most) medical technical skills were found. The lowest-scored instructional design features may be improved to achieve further learning aims.
ISRCTN Registry ISRCTN98617255; http://www.isrctn.com/ISRCTN98617255.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12884-020-03050-3.
基于模拟的培训是提高机构内产科服务质量的常见策略，并且常使用柯克帕特里克理论模型进行评估。柯克帕特里克各层级的结果与培训项目教学设计的质量密切相关。教学设计通常被定义为“一套关于教学方法的规定，旨在提高教学质量，以优化学习成果为目标”。
本研究旨在评估在低收入国家开展的一项技术增强型产科模拟培训的教学设计、参与者的反应以及对知识、团队协作和技能的影响。
在乌干达坎帕拉的一家年分娩量超过31000例的大学医院进行了一项阶梯楔形整群随机试验。2014年11月，安装了一个配备全身分娩模拟器（Noelle S550，Gaumard Scientific公司）、交互式新生儿模拟器（Simon S102新生儿心肺复苏模拟器，Gaumard Scientific公司）以及音频和视频录制系统的医学模拟中心。12名当地产科医生接受培训并获得医学模拟培训师认证。2014年至2016年，以6至9名学生为一组，对57名住院医师进行了培训。对通过42项ID - SIM（通过监测改进的模拟教学设计）测量的培训课程的十个教学设计特征进行了描述性统计。采用威尔科克森符号秩检验来研究知识、临床团队协作量表得分以及医学技术技能方面的差异。
十个教学设计特征的平均得分在100分制中从54.9（95%CI 48.5 - 61.3）到84.3（95%CI 80.9 - 87.6）不等。得分最高的特征是反馈，得分最低的是重复练习和受控环境。培训日的总体得分为100分中的92.8分（95%CI 89.5 - 96.1）。知识显著提高，培训前测试成绩为63.4%（95%CI 60.7 - 66.1），培训后为78.9%（95%CI 76.8 - 81.1）（P <.001）。10分制临床团队协作量表的总体得分培训前为6.0（95%CI 4.4 - 7.6），培训后为
