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

产后出血（PPH）是一种罕见的，但可能是灾难性的产科急诊， 严重的孕产妇发病率和可预防的死亡率在美国种族和少数民族群体的妇女 生活在服务不足和偏远地区的人面临的风险最大。产科单位必须准备好管理 PPH和产科（OB）主治医生必须保持必要的技术技能，以控制PPH。为了解决这个问题， 模拟是一种很有前途的方法。产科模拟已经显示出团队培训的有效性， 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 来自其他外科专业的模拟研究表明， 现有的高保真模拟器，并确定其在培训OB主治医师技术技能方面的有效性 需要管理PPH。然而，针对在不同医院工作的OB主治医师的模拟程序 全国各地的环境在实施和推广模拟方面遇到了已知的障碍。我们 提出一个分阶段的多中心研究，以建立模拟，使用创新的方法来减轻障碍， 作为一种有效的手段，培训产科主治医生在三个技术技能证明有效， 控制性PPH：Bakri球囊置入、B-Lynch缝线置入和O 'Leary缝线置入。OB 主治医生将在基线进行评估，指导和重新评估。主要结果将是 评估评分（通过经验证和广泛使用的OSATS测量）和OB百分比的变化 从基线到计划完成达到能力（60分）的主治医生。我们的主要假设 PPH技术技能模拟程序将显示OB技能水平的显著提高 主治医生和拟议的创新（负担得起的，远程，异步）将解决已知的障碍 执行。我们提出了以下具体目标：目标1：建立模拟作为一种有效的手段 通过验证高保真模拟器，培训产科主治医师治疗PPH的技术技能， 严格评估其有效性的PPH技术技能模拟程序与一个人 辅导计划。目标2：评估旨在克服模拟常见障碍的三项创新 OB主治医师培训：目标2A：开发一种新型的、负担得起的中等保真度模拟器，并评估其 PPH技术技能计划中使用面对面指导的有效性;目标2B：评估PPH技术 具有远程同步指导的技能模拟程序;目标2C：评估PPH技术技能 具有异步指导的模拟程序。目标3：评估PPH技术技能的有效性 在农村和社区医院设置模拟程序，使用的方法，充分解决了 在目标2中建立了实施障碍（可负担、远程、异步），并为OB所接受 主治医生如果成功，结果将为产科的最佳实践提供信息， 医学教育和培训标准，并能够在全国各种环境中传播。 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