Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial.

OBJECTIVE: To determine whether obstetric team training in a medical simulation centre improves the team performance and utilisation of appropriate medical technical skills of healthcare professionals. DESIGN: Cluster randomised controlled trial. SETTING: The Netherlands. SAMPLE: The obstetric departments of 24 Dutch hospitals. METHODS: The obstetric departments were randomly assigned to a 1-day session of multiprofessional team training in a medical simulation centre or to no such training. Team training was given with high-fidelity mannequins by an obstetrician and a communication expert. More than 6 months following training, two unannounced simulated scenarios were carried out in the delivery rooms of all 24 obstetric departments. The scenarios, comprising a case of shoulder dystocia and a case of amniotic fluid embolism, were videotaped. The team performance and utilisation of appropriate medical skills were evaluated by two independent experts. MAIN OUTCOME MEASURES: Team performance evaluated with the validated Clinical Teamwork Scale (CTS) and the employment of two specific obstetric procedures for the two clinical scenarios in the simulation (delivery of the baby with shoulder dystocia in the maternal all-fours position and conducting a perimortem caesarean section within 5 minutes for the scenario of amniotic fluid embolism). RESULTS: Seventy-four obstetric teams from 12 hospitals in the intervention group underwent teamwork training between November 2009 and July 2010. The teamwork performance in the training group was significantly better in comparison to the nontraining group (median CTS score: 7.5 versus 6.0, respectively; P = 0.014). The use of the predefined obstetric procedures for the two clinical scenarios was also significantly more frequent in the training group compared with the nontraining group (83 versus 46%, respectively; P = 0.009). CONCLUSIONS: Team performance and medical technical skills may be significantly improved after multiprofessional obstetric team training in a medical simulation centre.

Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review.

OBJECTIVE: To perform a systematic review of the literature on the effectiveness of multidisciplinary teamwork training in a simulation setting for the reduction of medical adverse outcomes in obstetric emergency situations. DATA SOURCES: We searched Medline, Embase, and the Cochrane Library from inception to June 2009. The search strategy contained medical subject heading terms ("patient care team" and "patient simulation" and "obstetrics" or "gynecology" and "education" or "teaching") and additional text words ("teamwork," "simulation," "training"). METHODS OF STUDY SELECTION: Studies describing and evaluating teamwork training programs with simulation models for labor ward staff in acute obstetric emergencies were selected. The search revealed 97 articles. TABULATION, INTEGRATION, AND RESULTS: All studies were assessed independently by two reviewers for methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) criteria. Only eight articles assessed the effect of teamwork training in a simulation setting. Four of them were randomized controlled trials and four were cohort studies. The only study that reported on perinatal outcome showed an improvement in terms of 5-minute Apgar score and hypoxic-ischemic encephalopathy. The seven other studies showed that teamwork training in a simulation setting resulted in improvement of knowledge, practical skills, communication, and team performance in acute obstetric situations. Training in a simulation center did not further improve outcome compared with training in a local hospital. CONCLUSION: Introduction of multidisciplinary teamwork training with integrated acute obstetric training interventions in a simulation setting is potentially effective in the prevention of errors, thus improving patient safety in acute obstetric emergencies. Studies on its effectiveness and cost-effectiveness are needed before team training can be implemented on broad scale.