Simulation for Attending Obstetricians to Improve Technical Skills for Managing Postpartum Hemorrhage

产后出血是一种罕见但具有潜在灾难性的产科急症，也是导致产后出血的主要原因。 美国少数民族妇女中严重的孕产妇发病率和可预防的死亡率 生活在服务不足和偏远地区的风险最大。产科单位必须做好管理的准备 产后出血和产科(OB)主治医师必须保持控制产后出血的必要技能。为了解决这个问题， 模拟是一种很有前途的方法。产科模拟已经显示了团队训练的有效性，但 有令人信服的证据表明，使用模拟来提高技术技能。此外，先前的研究和 来自其他外科专科的模拟研究表明，成功验证 现有高保真模拟器及其在OB主治医师技术技能培训中的有效性 需要管理PPH。然而，针对在不同医院工作的OB主治医生的模拟程序 全国各地的环境在实施和传播模拟方面受到已知的障碍。我们 提出阶段性、多中心研究以建立模拟，使用创新方法来减少障碍， 作为对OB主治医生进行三项技能培训的有效手段，该技能被证明对 控制PPH：Bakri球囊放置、B-Lynch缝合、O‘leary缝合。OB 将对主治医生进行基线评估、指导和重新评估。主要结果将改变为 评估分数(通过经过验证和广泛使用的OSAT衡量)和OB百分比的变化 从基线到课程完成达到能力要求(60分)的主治医生。我们的主要假设 PPH技术技能模拟计划将显示OB的技能水平显著提高 建议的创新(负担得起的、远程的、异步的)将解决已知的障碍 到实施。我们提出了以下具体目标：目标1：将仿真作为一种有效的手段 通过验证高保真模拟器，培训OB主治医生治疗PPH的技术技能 通过面对面评估PPH技术技能模拟项目的有效性 指导计划。目标2：评估旨在克服模拟常见障碍的三项创新 对OB主治医生的培训：目标2A：验证一种新的、负担得起的中等保真度模拟器并评估其 使用面对面指导的PPH技术计划的有效性；目标2B：评估PPH技术 具有远程同步指导的技能模拟计划；目标2C：评估PPH技术技能 带有异步指导的模拟程序。目标3：评估PPH技术技能的有效性 农村和社区医院环境中的模拟计划，使用的方法充分解决了 目标2中设置的实施障碍(负担得起的、远程的、异步的)，OB可以接受 主治医生。如果成功，结果将为产科的最佳实践提供参考，促进模拟在 医学教育和培训标准，并使其能够在全国范围内的不同环境中传播。 1

Postpartum hemorrhage (PPH) is a rare but potentially catastrophic obstetric emergency, and a leading cause of severe maternal morbidity and preventable mortality in the U.S. Women of racial and ethnic minority groups and living in underserved and remote areas are at greatest risk. Obstetric units must be prepared to manage PPH, and obstetric (OB) attendings must maintain technical skills necessary to control PPH. To address this, simulation is a promising approach. Obstetric simulation has shown effectiveness for team-based training, yet there is compelling evidence for the use of simulation to improve technical skills. Further, prior studies and simulation research from other surgical specialties demonstrate the high likelihood of successfully validating an existing high-fidelity simulator and establishing its effectiveness in training OB attendings in technical skills needed to manage PPH. However, a simulation program directed at OB attendings who work in varied hospital settings across the country is subject to known obstacles for implementing and spreading simulation. We propose a staged, multicenter study to establish simulation, using innovative approaches to mitigate barriers, as an effective means for training OB attendings in three technical skills demonstrated as effective for controlling PPH: Bakri balloon placement, B-Lynch suture placement, and O'Leary suture placement. OB attendings will be assessed at baseline, mentored, and re-assessed. The primary outcomes will be change in assessment scores (measured by validated and widely used OSATS) and change in percentage of OB attendings who achieve competency (score of 60) from baseline to program completion. Our main hypotheses are that the PPH technical skills simulation program will show a significant increase in skill level among OB attendings and that the proposed innovations (affordable, remote, asynchronous) will address known barriers to implementation. We propose the following specific aims: Aim 1: Establish simulation as an effective means for training OB attendings in technical skills for treating PPH by validating a high-fidelity simulator and rigorously evaluating its effectiveness for a PPH technical skills simulation program with an in-person mentoring program. Aim 2: Evaluate three innovations aimed at overcoming common barriers to simulation training for OB attendings: Aim 2A: Validate a novel, affordable medium-fidelity simulator and evaluate its effectiveness in a PPH technical skills program using in-person mentoring; Aim 2B: Evaluate a PPH technical skills simulation program with remote synchronous mentoring; Aim 2C: Evaluate a PPH technical skills simulation program with asynchronous mentoring. Aim 3: Evaluate the effectiveness of a PPH technical skills simulation program in rural and community hospital settings, using the approach that sufficiently addresses the barriers to implementation established in Aim 2 (affordable, remote, asynchronous) and is acceptable to OB attendings. If successful, results will inform best practices in obstetrics, advance integration of simulation in medical education and training standards, and enable dissemination in varied settings nationwide. 1