Obstetric simulation as a risk control strategy: course design and evaluation
Introduction: Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. Methods: We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. Results: The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. Conclusions: A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF’s obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.
Chi-square statistics used on the last phase to analyze the results of the questionnaire.
Systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more post-training follow-up with self-assessment questionnaires.
Self-assessment of team performance on teamworkSelf-assessment of own performance on teamwork
Phases:Pilot course development and evaluation of its immediate impactObstetric simulation-based team training course and evaluation (systematic design and implementation)1-year or longer post-course evaluation with self-assessment questionnaires.
Through simulation + surveys
Describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles.
There may be other models of communication and teamwork education that are also effective. Using self-report to evaluate transfer of training to the real domain has inherent limitations (e.g. learned tend to overestimate their performance and over attribute their improvements to the course).The use of self-reports to evaluate courses is a relatively weak measure of effectiveness compared with other forms of testing.
A simulation-based team-training course for multidisciplinary L&D clinicians was developed and now is a central component of a risk management loss prevention program.Formal training in communication and teamwork for L&D clinicians seems to be a plausible strategy for preventing or mitigating adverse perinatal events.
A simulation-based team-training course for obstetric clinicians was developed and is a central component of the Controlled Risk Insurance Company (CRICO) / Risk Management Foundation (RMF’s) obstetric risk management incentive program.
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