Abstract
The use of simulation is a method of training for both individuals and teams. It allows learners to acquire skills in a non-threatening environment while avoiding harm to patients. It can be harnessed as a tool for learning a new skill or procedure through to exposing teams of experienced personnel to an innovative approach to develop or consolidate technical and non-technical skills incorporating teamwork skills.
Simulation-based training provides experiential opportunities for development of team cognition that may build upon, or even replace actual clinical experience, this being particularly beneficial for critical clinical incidents scenarios that are fortunately rare or uncommon within obstetrics, for example maternal cardiac arrest, amniotic fluid embolism and eclampsia as well as rehearsal for use of protocols, for example sepsis care bundles.
The use of simulation is a method of training for both individuals and teams. It allows learners to acquire skills in a non-threatening environment while avoiding harm to patients. It can be harnessed as a tool for learning a new skill or procedure through to exposing teams of experienced personnel to an innovative approach to develop or consolidate technical and non-technical skills incorporating teamwork skills.
Simulation-based training provides experiential opportunities for development of team cognition that may build upon, or even replace actual clinical experience, this being particularly beneficial for critical clinical incidents scenarios that are fortunately rare or uncommon within obstetrics, for example maternal cardiac arrest, amniotic fluid embolism and eclampsia as well as rehearsal for use of protocols, for example sepsis care bundles.
Furthermore, simulation-based training can be used to develop individual skills that can translate to team settings, thus addressing some of the challenges associated with ad hoc teams. Simulated clinical experiences can help individuals develop knowledge about the expertise and skills held by other professions and about the various roles within the team [1].
Opportunities are provided by simulation training for teams to work together and develop both shared understanding of the team, tasks, equipment and patterns of communication as well as a networked system of expertise accessible to team members when needed. Through simulated experiences, team members gain exposure to exchange of ideas and insights, thus building collaborative knowledge and shared understanding.
Types of Simulation Training
Within obstetrics a spectrum of simulation types can be used, depending on availability of resources, time, participants and experience of training faculty. These include simple role playing, simulated patients, part task trainers, hybrid modules, full body mannikins with physiology and simulated environments.
Role of Simulation Training Within Obstetrics
Introduce and explore the concept of human factors.
Development of technical and non-technical skills (situational awareness, communication, leadership)
For individual and team training, especially to explore communication across specialties and professions, for example neonatal, anaesthetic, theatre staff, midwifery and other key team members such as porters and support workers
Rehearsal of rare events, for example maternal cardiac arrest
Re-create critical incidents within a unit to allow for system error recognition as part of a combined risk reduction/ education strategy, that is, to complete an Action Plan from a Risk Management or Serious Incident Case.
Facilitate medical device and procedure training, for example instrumental birth, B-Lynch suture
Risk assessment of clinical areas and equipment usage to ensure safety and logistical aspects are considered for all staff and patients.
Simulation Training Requirements
Simulation training personnel who have acquired teaching experience, enthusiasm and time allocated for simulation sessions.
Technical staff available or trained faculty if high-fidelity technical mannikins are to be used
Predesigned scenarios and tool for evaluation of simulation training session
Time to deliver training which can be in the form of mandatory study days where staff are released from clinical duties and/or as part of ‘fire-drills’ where training occurs on wards using real teams carrying out clinical duties. Drills always carry the possibility that clinical areas may be too busy and that training will present too great a pressure, so rescheduling may be necessary.
Setting the scene explaining the equipment to be used and scenario to be undertaken and/or as a minimum for an unannounced ‘fire-drill’, giving a brief history and explanation of expected actions. Within team simulation training, it is often useful to advise participants that no assessments are being made and suggest an agreement with all present that where appropriate, actions by individuals remain anonymous to maintain confidentiality. This can reinforce the secure learning environment.
Participants should include the involvement of a multiprofessional training team, from midwifery through to obstetric, anaesthetic, theatre and ancillary (e.g. portering, laboratory) staff in order to represent the key professionals who will benefit most from re-creating a clinical situation.
Debrief and Feedback
Facilitated post-event feedback and reflective debriefing discussions represent a key component of simulation-based education to augment future performance. Debriefing has been defined as ‘a discussion between two or more individuals in which aspects of a performance are explored and analyzed, with the aim of gaining insights that impact the quality of future clinical practice’ [2]. It is a form of reflective practice and provides a means of reflection on action in the process of continuous learning. The quality of the debriefing and eventual impact on learning outcomes are highly dependent on the performance of the educator who facilitates the debriefing. The debriefing session allows participants to integrate the experience with the theoretical frameworks and procedural guidelines.
Feedback is often used synonymously with debriefing; however, there are important distinctions. Feedback in the context of simulation can be defined as information about performance to participants with the intent to modify thinking or behaviour to facilitate learning and improve future performance. It is one way and must be non- judgmental. In contrast, debriefing is multidirectional: an interactive conversation and/or discussion both between participants and with the facilitator(s) which can also facilitate reflection and, where needed, guidance [3].
The debrief of a simulation-based training session can also be designed to allow consideration of ethical issues encountered within clinical multidisciplinary scenarios, for example failed intubation at caesarean section and refusal of blood products to allow exploration of difficult issues with the whole team with regard to rights of the mother and the fetus.
Report Writing and Actions
Disseminating the learning outcomes from this form of training is paramount to sharing the experience with a whole unit. Simulation is time and labour intensive and clinical workload itself often prohibits optimum frequency of delivery of training. In addition due to working patterns it is often not possible to encompass all staff. Reports allow for shared learning and for staff to discover where working environment or system difficulties have been revealed through training exercises, and improvements put in place as a result. Other forms for learning from aspects of simulation that took place include articles in a risk newsletter, poster and/or presentation at clinical governance forums. Lessons learning from simulation-based training should be fed back into the risk management system.
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