Lee Menelik M H, Chan Chao Ngan, Lau Betty Y T, Ma Teresa W L
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
BMJ Simul Technol Enhanc Learn. 2017 Oct 3;3(4):142-148. doi: 10.1136/bmjstel-2017-000195. eCollection 2017.
Current evidence suggests annual training in the management of shoulder dystocia is adequate. The aim of this trial is to test our hypothesis that skills start to decline at 6 months after training and further decline at 12 months.
In this randomised, single-blinded study, 13 obstetricians and 51 midwives were randomly assigned to attend a 1-hour mixed lecture and simulation session on shoulder dystocia management. Training was conducted on group 2 at month '0' and on group 1 at month '6'. Their knowledge scores (primary outcome) were assessed before (pre-training), immediately after the training (at-training) and retested at month '12' (post-training).
Two-way repeated-measures analysis of variance showed a statistically significant interaction between the testing time frame (pre-training, at-training and post-training) on the score (p<0.001), but no significant interaction between the groups on the score (p=0.458).Compared to pre-training, the score increased after the simulation training (at-training) in both group 1 (8.69 vs 14.34, p<0.001) and group 2 (9.53 vs 14.66, p< 0.001), but decreased at 6 months post- training in group 1 (14.34 vs 11.71, p<0.001) and at 12 months post-training in group 2 (14.66 vs 11.96, p< 0.001). However the score was better than before the training. There was no significant difference in the post -training score (11.71vs 11.96, p=0.684) between both groups.
Our study demonstrated that simulation training results in short-term and long-term improvement in shoulder dystocia management however knowledge degrades over time. Ongoing training is suggested at a minimum of 12 months' interval for all members of the obstetrics team including midwives and doctors.
目前的证据表明，每年进行肩难产管理培训就足够了。本试验的目的是检验我们的假设，即技能在培训后6个月开始下降，并在12个月时进一步下降。
在这项随机、单盲研究中，13名产科医生和51名助产士被随机分配参加为期1小时的关于肩难产管理的混合讲座和模拟课程。第2组在“0”月接受培训，第1组在“6”月接受培训。在培训前（培训前）、培训后立即（培训时）和“12”个月（培训后）对他们的知识得分（主要结果）进行评估。
双向重复测量方差分析显示，测试时间框架（培训前、培训时和培训后）与得分之间存在统计学上的显著交互作用（p<0.001），但两组之间在得分上没有显著交互作用（p=0.458）。与培训前相比，第1组（8.69对14.34，p<0.001）和第2组（9.53对14.66，p<0.001）在模拟培训后（培训时）得分均有所提高，但第1组在培训后6个月（14.34对11.71，p<0.001）和第2组在培训后12个月（14.66对11.96，p<0.001）得分下降。然而，得分仍高于培训前。两组之间的培训后得分（11.71对11.96，p=0.684）没有显著差异。
我们的研究表明，模拟培训可在短期和长期内改善肩难产管理，但知识会随着时间推移而退化。建议包括助产士和医生在内的产科团队所有成员至少每隔12个月进行一次持续培训。
