Delivery Room Simulation Improves Obstetrics Training

Most of the time, families enjoy happy outcomes in Labor and Delivery at Packard Children’s. But when obstetrical emergencies arise, medical staff face intense time pressure and the challenge of caring for mother and baby simultaneously. With an Innovations in Patient Care Grant supported by the Children’s Fund, Kay Daniels, MD, clinical associate professor of obstetrics and gynecology, investigated a dynamic method for training medical staff to respond to such crises swiftly and effectively.

In recent years, the medical community has grown increasingly interested in simulation technology that recreates the experience of performing under pressure. ''Other groups, like orchestras and football teams, routinely practice together,'' says Daniels. ''But in medicine, where teamwork has critical consequences, the opportunities for practice have traditionally been very limited. Simulation gives us a safe way to practice without danger to patients.''

Daniels studied the efficacy of an education program called OBSim, developed at Packard and Stanford, that replicates the conditions in delivery rooms using real medical equipment and highly advanced mannequins. Trainers remotely control the ''patient,'' creating simulated crises that force students to react in real time. The simulation is then followed by a lengthy debriefing session that allows the group to discuss ways to improve their performance.

Daniels compared two groups of obstetrical residents and nurses learning how to handle rare but dangerous labor complications. The first group underwent a traditional training program combining lecture, a video presentation, and practice with a model, while the second group took the OBSim class. One month later, the two groups’ scores were equal on a written test. In a performance test, however, the OBSim group significantly outperformed their counterparts.

''Our study has shown that simulation training allows health care personnel to ‘experience’ obstetrical crises and improve team performance,'' says Daniels. Thanks to the Children’s Fund, this innovative approach to education will help future practitioners confidently care for their most vulnerable patients.