Virtual Reality-Enhanced Haptic Simulation to Improve Self-Regulation of Applied Delivery Force During Shoulder Dystocia

肩部难产，指婴儿在最后一次分娩时头部露出后，肩部和身体的难产。 在每25次阴道分娩中，就有1次是不可预测的产科急症。快速识别和 实施专门的递送动作可以减轻高达40%的臂丛神经损伤 肩部难产--复杂的分娩。虽然模拟训练已经取得了一些成功，但请重新 臂丛神经损伤的减少率并没有始终如一地实现。关于不同模拟的问题仍然存在 在成功干预和不成功干预之间使用的培训方案和教学内容。除非内容 肩部难产模拟训练的方法在减轻产伤方面是有效的，使用模拟。 获取技能的方法在提高患者安全方面的作用有限。如果模拟导出的度量没有被验证， 否则，称职的产科医生可能会被错误地视为没有适当的技能，导致劳动力重新... 对妇女和儿童获得安全产科护理产生不利影响的引流。我们描绘了特定的积极(预 (描述性的)强调动作可以减少臂丛神经紧张的教学内容。我们还考虑了 几个负面(禁止性)指示--以避免过度和横向或扭转牵引--是必要的 包括在模拟训练中。我们使用虚拟(视频)和触觉(人体模型)提供相关的学习内容- MATS，并对提供者技术进行客观(力量测量)和主观(指导者得分)评估。 尽管在减少临床臂丛损伤方面取得了成功，但这些计划都是劳动密集型的，而且很少针对 提供者的教育需求。我们的产科、生物医学工程和模拟多学科协作团队 阿尔伯特·爱因斯坦医学院蒙蒂菲奥里医学中心的教育工作者提出了一种虚拟现实增强触觉 模拟以改善产科提供者在肩部难产期间对所用产力的自我调节。混合冰毒- 将使用ods方法来评估我们在技能获取和能力评估方面的新内容和格式 肩部难产的提供者处理。此应用程序的总体目标是确定相对内容- 正反两方面的教学内容，虚拟和触觉的模拟训练方法。我们的中央- 假设是，刻意的示意性教学可以提高技能习得，减少不正当的潜在伤害-- 制作技术。我们的目标是：1)评估正面和负面教学内容对教学效果的相对贡献。 基于虚拟仿真的技能获取和能力；2)评估虚拟和触觉的仿真培训方法 肩部难产处理和3)验证客观和主观模拟导出的指标用于演示 将技能转化为临床实践。拟议研究的预期结果是能够可靠、高效和 通过定制的集成虚拟和触觉组件，有效地交付基于证据的验证模拟计划 提供对减少肩难产后臂丛神经损伤的能力有积极影响的体验。

Shoulder dystocia, the obstructed delivery of an infant's shoulders and body after emergence of the head in the final mo- ments of birth, occurs unpredictably as an obstetric emergency in up to 1 in 25 vaginal deliveries. Prompt recognition and performance of specialized delivery maneuvers mitigates against brachial plexus injuries associated with up to 40% of shoulder dystocia-complicated deliveries. Although some success with simulation training has been demonstrated, re- duced rates of brachial plexus injury has not been achieved consistently. Questions persist about differing simulation training schemes and instructional content utilized between successful and unsuccessful interventions. Unless content and methodology utilized for shoulder dystocia simulation training is proven effective in mitigating birth injury, use of simu- lation for skills acquisition is of limited utility in advancing patient safety. If simulation-derived metrics are not validated, otherwise competent obstetricians could be inaccurately deemed not to be appropriately skilled, leading to workforce re- ductions that negatively impact access to safe obstetric care for women and children. We delineate specific positive (pre- scriptive) instructional content emphasizing maneuvers shown to decrease strain on the brachial plexus. We also consider several negative (proscriptive) instructions – to avoid excessive and laterally-directed or torsional traction – to be essential for inclusion in simulation training. We deliver relevant learning content using virtual (video) and haptic (mannequin) for- mats and perform objective (force measurement) and subjective (preceptor scores) assessments of provider technique. Although successful in reducing clinical brachial plexus injuries, such programs are labor-intensive and rarely tailored to providers' educational needs. Our multidisciplinary collaborative team of obstetric, biomedical engineering and simulation educators from Albert Einstein College of Medicine-Montefiore Medical Center proposes a virtual reality-enhanced haptic simulation to improve obstetric providers' self-regulation of applied delivery force during shoulder dystocia. A mixed meth- ods approach will be used to evaluate our novel content and format for skills acquisition and competency assessment of providers' management of shoulder dystocia. The overall objective for this application is to determine the relative contribu- tion of positive and negative instructional content and of virtual and haptic methods of simulation training. Our central hy- pothesis is that deliberate demonstrative instruction improves skill acquisition and reduces improper potential injury- producing techniques. We aim to 1) assess the relative contribution of positive and negative instructional content to effec- tive simulation-based skill acquisition and competency; 2) evaluate virtual and haptic methods of simulation training for shoulder dystocia management and 3) validate objective and subjective simulation-derived metrics for demonstrating transfer of skills to clinical practice. The expected outcome of the proposed research is the ability to reliably, efficiently and effectively deliver an evidence-based validated simulation program with integrated virtual and haptic components tailored to provider experience that positively impacts the ability to reduce brachial plexus injuries following shoulder dystocia.