A novel "video-game" simulator for training fetoscopic laser coagulation of anastomoses in twin-to-twin transfusion syndrome.

 : We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The use of simulation improves training of the fetoscopic laser techniques utilized in the treatment of twin-twin transfusion syndrome A number of mannequins have been developed to aid this education WHAT DOES THIS STUDY ADD?: Two new simulators are described for twin-twin transfusion syndrome training-silicone and digital The digital simulator is a novel digital video game virtual format This new format has enhanced interactivity and has the potential to enable distance learning.

Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations.

BACKGROUND: Hypertensive disorders of pregnancy (including preeclampsia or gestational hypertension) are associated with fetal growth restriction in singleton pregnancies, an association that may be attributed to abnormal placentation as the shared etiology between these conditions. Given that the pathogenesis of these conditions in twin pregnancies may involve mechanisms other than abnormal placentation, it is unclear whether a similar association between hypertensive disorders of pregnancy and fetal growth restriction is present in twins. Data on the relationship between hypertensive disorders of pregnancy and fetal growth restriction in twins are limited and conflicting. This controversy may be attributed to limitations of existing studies including the use of a singleton-based birthweight reference to define fetal growth restriction in twins and the lack of a positive control group of singleton gestations. OBJECTIVE: The objective of the study was to determine the association between hypertensive disorders of pregnancy and fetal growth restriction in dichorionic twin gestations, using both a singleton- and a twin-based birthweight reference, and to compare this association with that observed in singleton gestations. STUDY DESIGN: We performed a retrospective cohort study of all women with dichorionic twin or singleton gestations giving birth in a single tertiary center during 2003-2015. Fetal growth restriction was defined in separate analyses as birthweight <10th percentile for gestational age using either a singleton- or a twin-based birthweight reference. The association between hypertensive disorders of pregnancy and fetal growth restriction was determined separately for twin and singleton gestations and was expressed as adjusted relative risk with 95% confidence interval. RESULTS: A total of 1520 twin and 48,943 singleton gestations were included. In singleton gestations, hypertensive disorders of pregnancy were associated with an increased risk of fetal growth restriction (16.6% vs 7.4%, adjusted relative risk, 2.07, 95% confidence interval, 1.87-2.30). In twins, there was no association between hypertensive disorders of pregnancy and fetal growth restriction when a singleton-based reference was used to define fetal growth restriction. However, when using a twin-based reference to define fetal growth restriction, hypertensive disorders of pregnancy in twin gestations were associated with a similar increase in the risk of fetal growth restriction to that seen in singletons (11.8% vs 4.7%, adjusted relative risk, 2.37, 95% confidence interval, 1.69-3.34). Findings were similar with regard to the reverse association between fetal growth restriction and hypertensive disorders of pregnancy: in women with twin gestations, the increase in the risk of hypertensive disorders of pregnancy in pregnancies complicated by fetal growth restriction of 1 twin was similar to that observed in singletons only when a twin-based reference was used to define fetal growth restriction (twins: 21.3% vs 9.8%, adjusted relative risk, 2.15, 95% confidence interval, 1.63-3.06; singletons: 8.8% vs 3.7%, adjusted relative risk, 2.19, 95% confidence interval, 1.95-2.44). CONCLUSION: The association between hypertensive disorders of pregnancy and fetal growth restriction in dichorionic twins is similar in magnitude to that observed in singletons so long as appropriate birthweight references are applied. Therefore, women with a twin gestation complicated by one of these conditions should be closely monitored for the other. Our findings suggest that the use of a twin-based reference to diagnose fetal growth restriction in twin gestations may be more informative and clinically relevant than using a singleton-based reference.

Conflict Among Colleagues: Health Care Providers Feel Undertrained and Unprepared to Manage Inevitable Workplace Conflict.

OBJECTIVE: In the health care sector, intercollegial conflict is inevitable. Such conflict may have an adverse effect on employee turnover, workplace morale, and patient safety and care. Conversely, skillful management of conflict may result in beneficial change and improvement. Improved conflict management (CM)/dispute resolution (DR) knowledge for health care professionals (HCPs) has been shown to reduce the negative impacts of conflict. This study aimed to determine whether HCPs feel equipped to manage collegial workplace conflict and whether they feel there is a need for CM training. METHODS: An electronic survey was developed to determine the attitudes, experience, and background training HCPs have had with CM, as well as whether respondents felt they needed CM/DR training. The survey was emailed to 660 HCPs in 2013 at Sunnybrook Health Sciences Centre, Toronto, Ontario. RESULTS: The response rate was 46% (303 of 660). Of 303 respondents, 128 (42%) reported previous formal training in CM/DR, but only 80 of 303 (26%) felt adequately trained to manage conflict and resolve disputes in the workplace, with 59% believing they need more conflict training. Among respondents, 76% wanted to see these skills incorporated into their own career training opportunities, but only 34% were aware of courses available to improve their CM/DR skills, and 50% stated they would be interested in taking such courses; 79% wanted to see these skills incorporated into medical school curricula. CONCLUSION: This needs assessment survey found that most HCPs did not believe that they have adequate training to manage workplace conflict comfortably, and they felt more training is needed in CM/DR.

Teaching an Experienced Multidisciplinary Team About Postpartum Hemorrhage: Comparison of Two Different Methods.

OBJECTIVE: Morbidity from postpartum hemorrhage (PPH) affects 20% of pregnancies worldwide and remains a significant cause of maternal mortality. This study compared the impressions of experienced clinicians on the effect of two methods of educational interventions in a MoreOB training program designed to improve recognition and management of PPH. METHODS: Participants were exposed to a traditional didactic lecture and an interactive clinical intervention exercise incorporating video simulation of a PPH event with opportunities for feedback and discussion of how to proceed. They were then invited to respond to a questionnaire regarding their impressions of both methods. RESULTS: Of 150 participants, 110 completed the questionnaire. Respondents considered the interactive format to be more effective (55%) and enjoyable (72%) than the traditional didactic format. The majority (81%), however, still recommended a mixture of both interactive and didactic formats in future events, supported by a multidisciplinary drill. CONCLUSION: Clinical learners value interactivity and mutual reinforcement among varied learning exercises in their educational experiences. Future educational programs may consider incorporating similar methods in order to maximize participants' receptiveness.

Objectif : La morbidité attribuable à l'hémorragie postpartum (HPP) affecte 20 % des grossesses à l'échelle mondiale et demeure une cause importante de mortalité maternelle. Cette étude a comparé les impressions de cliniciens expérimentés quant aux effets de deux méthodes d'intervention pédagogique (dans le cadre d'un programme de formation AMPROOB) conçues pour améliorer la reconnaissance et la prise en charge de l'HPP. Méthodes : Les participants ont pris part à un exposé magistral traditionnel et à un exercice interactif d'intervention clinique alliant la simulation vidéo d'un événement d'HPP à des occasions de formuler des commentaires et de participer à des discussions sur la façon de procéder. Nous les avons par la suite conviés à répondre à un questionnaire au sujet de leurs impressions quant à ces deux méthodes. Résultats : Cent dix des 150 participants ont rempli le questionnaire. Les répondants étaient d'avis que le format interactif était plus efficace (55 %) et plaisant (72 %) que le format magistral traditionnel. La majorité d'entre eux (81 %) ont cependant recommandé l'offre d'une approche mixte intégrant les deux formats dans le cadre des événements à venir, le tout devant alors être soutenu par la tenue d'un exercice d'entraînement multidisciplinaire. Conclusion : Dans le domaine clinique, les apprenants accordent de l'importance à l'interactivité et au renforcement mutuel de divers exercices d'apprentissage dans le cadre de leurs expériences pédagogiques. Les futurs programmes pédagogiques pourraient envisager l'intégration de méthodes semblables afin de maximiser la réceptivité des participants.