Learning Objectives
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Recognize the difference between technical and non-technical skills training.
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Describe the importance of teamwork training.
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List strategies for team-based safety training.
The goal of each obstetrician and each labor and delivery unit is a safe birth for both newborn and mother. In 2010, the Joint Commission published a Sentinel Event Alert about rising maternal mortality rates and our need to address them. Up to half of the maternal deaths are preventable. In 2001, the Institute of Medicine stated, “Health care organizations should establish interdisciplinary team training programs for clinicians to incorporate the proven team training strategies used in the aviation industry.” Since the publication of that report, a series of measures have been proposed and adopted in obstetrics and in medicine in general. Simulation training plays a paramount role in obstetrics for improving perinatal outcome.
Management of any obstetric emergency requires both technical and non-technical skills. Technical skills include identifying the correct procedure and knowing how to do it. Examples are one’s knowing the appropriate dose of epinephrine to give to a patient in anaphylaxis or knowing how to correctly apply forceps blades.
Non-technical skills can be more challenging to define but are essential to the success of an obstetrics team. These skills include communication with patients, partners, and team members, situational awareness, task management, and teamwork protocols. Team members will benefit from practicing specific communication strategies, including the following ( Fig. 1.1 ) :
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Call-out —Clearly informing all team members regarding important information. For example, stating directly, “There is a cord prolapse.”
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Directed communication —Using eye contact and names when possible. For example, “Sally, please start an IV.”
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Closed-loop communication —Repeating back the information as communicated to ensure that it was properly received. For example, “Okay. I am starting an IV.”
Both technical and non-technical skills can be developed through simulation. Simulation is used to avoid exposing patients to students’ learning curves and to prepare health professionals to manage conditions that are not frequently experienced, but need to be managed promptly and effectively. The practice of simulation in obstetrics in the United States was common in the 19th century when women delivered at home and not at the hospital. With more deliveries occurring in hospitals, trainees were exposed to a large obstetric population and the simulation practice became unimportant. It has been rediscovered in the last 20 years.
Simulation can be adapted to fit the needs and budget of any department. It can be as simple as walking through the algorithm for treatment of antepartum hypertension or as complex as performing procedures on a high-fidelity mannequin. Simulations should be as realistic as possible with the materials available. Fig. 1.2 shows the plan of the simulation laboratory at the University of Tennessee Health Science Center (UTHSC) in Memphis. It is a state-of-the-art lab.
