Which of the following is true/false with regard to the Kirkpatrick model of programme evaluation?

• a)

  The Kirkpatrick model is a statistical programme evaluation package.

• b)

  Kirkpatrick’s model of programme evaluation differentiates between five different levels of change.

• c)

  Most training courses do not evaluate effectiveness beyond immediate benefits of training in terms of individuals’ knowledge and skills.

• d)

  Kirkpatrick levels 3 and 4 focus on measuring individual performance.

• e)

  Level 4c of the revised Kirkpatrick classification pertains to the impact of training on patient outcomes.

Which of the following is true/false with regard to the nature of emergency obstetric and neonatal care (EmONC) training?

• a)

  Most EmONC training packages reported on in the scientific literature written in English have been developed in low- and middle-income countries.

• b)

  Simulation alone can be as effective as a package with lectures and simulation.

• c)

  Teamwork training is always associated with a reduction in morbidity and mortality.

• d)

  Running emergency drills using patient-actors and realistic low-tech models is less effective than training in a simulation centre with high-fidelity models.

• e)

  Refresher courses are essential for knowledge and skill retention.

Which of the following is true/false with regard to the impact of EmONC training?

• a)

  No randomised controlled trial has investigated the impact of an EmONC package yet.

• b)

  Assessing impact with respect to maternal and neonatal mortality is easier in low- and middle-income countries.

• c)

  The incidence of HIE does not decrease with simulation training.

• d)

  Training in the management of shoulder dystocia by means of mannequins can reduce the incidence of brachial plexus injury.

• e)

  Training embedded in a quality-improvement intervention can have a higher impact than stand-alone training.

Which of the following is true/false with regard to important directions for EmONC training?

• a)

  EmONC training can make a difference in high- and low-income countries.

• b)

  It is preferable to conduct EmONC training in simulation centres.

• c)

  Most EmONC training packages in low- and middle-income countries are embedded in countries’ health systems as part of normal in-service training and practice.

• d)

  EmONC training packages should include quality assurance and monitoring and evaluation mechanisms.

• e)

  Research shows that annual refreshers in EmONC should be recommended.

Mrs. P a, 45 year old pregnant woman at term collapses in front of the nursing staff while waiting in the delivery room. She is unresponsive and has no pulse. The midwife activates the emergency response system and begins chest compressions. A team of 2 doctors and 2 nurses arrive with the emergency equipment.

• a)

  The first thing one should do is displace the uterus to the left whilst chest compressions is ongoing

• b)

  One should follow BLS guidelines and perform chest compressions on the sternum at the inter-nipple line

• c)

  One should do 2 minutes of CPR before considering defibrillation in this patient.

• d)

  The doctors should transfer the patient to theatre for an urgent Caesarean delivery

• e)

  Intubation should only be considered after return of spontaneous circulation

You, as the head of the clinical service, decide to improve the competencies of the healthcare workers employed in your maternity unit by introducing the ESMOE with its EOSTs into the weekly continuing medical education programme. After conducting the fire drill, you notice that the performance of staff was poor. In addition, it was noted that you unit lacks essential basic emergency equipment.

• a)

  The best way to improve performance is to ask the staff to go home and read the ESMOE material

• b)

  You should show the staff how to do the skills correctly and have them observe you.

• c)

  You should ask the nurse in charge to make note of the missing equipment so that this may be discussed at the next perinatal meeting.

• d)

  Repeating the fire-drill is a good way of ensuring that staff understand the emergency pathways

• e)

  Fire-drills helps improve team work and collaboration

The following is/are true statements regarding communication and leadership during an obstetric emergency:

• a)

  Debriefing following a traumatic birth is always beneficial

• b)

  SBAR stands for Situation Background Assessment Response

• c)

  Closed-loop communication minimises misunderstandings

• d)

  The leader should be the most senior member of the team

• e)

  Checking the capabilities of individual team members during the emergency leads to unnecessary delays in management

The following is/are true statements relating to the maternal and neonatal risks of poor team working:

• a)

  The most recent confidential enquiry states that deficiencies in teamwork and leadership are no longer a problem in obstetrics

• b)

  The most recent confidential enquiry states that the management of PPH has the most problems

• c)

  In the UK, 10% of women face a potentially life threatening emergency in labour

• d)

  Communication problems are the most common root causes for perinatal death in developed countries

• e)

  Errors in the management of cardiac arrests are rare

The following is/are true statements regarding training for obstetric emergencies:

• a)

  Training for emergencies such as shoulder dystocia or vaginal breech should be done individually to allow participants to learn the manual skills required

• b)

  Evidence shows a sustained improvement in knowledge and skills 1 year following training.

• c)

  Attending Advanced Life Support training is sufficient team training for the management of maternal cardiac arrest

• d)

  Training should ideally take place in simulation centres with computerised patient mannequins

• e)

  Multi-professional ‘skills and drills’ training is mandatory in the UK

With regard to obstetric emergency training programmes, the following is/are true:

• a)

  Improvements in confidence and knowledge are always sustained over time

• b)

  Training in simulation centres is more effective than local training

• c)

  Training in simulation centres is more expensive than local training

• d)

  There is limited understanding of the processes and mechanisms underpinning successful training

• e)

  Clinical knowledge improvement translates into improved clinical outcomes

Regarding teamwork training which of the following is/are true?

• a)

  Poor teamwork is identified in cases of preventable morbidity and mortality in maternity care

• b)

  More efficient teams in emergency simulations do not need to verbally state the emergency as everyone intuitively knows what is happening

• c)

  Isolated teamwork training is clinically effective

• d)

  Good leaders use closed-loop communication techniques

• e)

  SBAR communication can improve patient perception of safety

Which of the following is true/false with regard to the three basic building blocks of EmONC programmes that need simultaneous attention?

• a)

  An assurance of political will, patients to attend emergency services, development of audit systems

• b)

  Training and developing skilled and knowledgeable clinicians, allocating appropriate resources, a reliable referral transport system

• c)

  Increase in available technology, training of clinicians, prior testing of the intervention

• d)

  Health care services to allocate funding, a reliable referral transport system, a commitment to meeting signal functions

• e)

  Stakeholder meetings, death reviews, integration into medical school curricula

What is the correct order suggested for the six stages of change needed for an EmONC scale-up agenda?

• a)

  Create awareness, commit to implement and scale up an EmONC programme, prepare to implement an EmONC programme, implement the EmONC programme, integrate EmONC into routine practice, sustain EmONC

• b)

  Prepare to implement an EmONC programme, create awareness, implement the EmONC programme, commit to implement and scale up an EmONC programme, integrate EmONC into routine practice, sustain EmONC

• c)

  Implement the EmONC programme, integrate EmONC into routine practice, create awareness, prepare to implement an EmONC programme, commit to implement and scale up an EmONC programme, sustain EmONC

• d)

  Create awareness, prepare to implement an EmONC programme, integrate EmONC into routine practice, commit to implement and scale up an EmONC programme, implement the EmONC programme, sustain EmONC

• e)

  Commit to implement and scale up an EmONC programme, prepare to implement an EmONC programme, create awareness, implement the EmONC programme, integrate EmONC into routine practice, sustain EmONC

Which of the following is/are true regarding the conditions for the scale up of an EmONC programme?

• a)

  The outcomes of any EmONC program may be impacted negatively if women requiring the service do not have transport to access it

• b)

  The need for EmONC services is so great that it is not imperative for political will and public policy to focus on scale up in order for scale up to work

• c)

  Drivers of scale up of EmONC programmes may need to first consider the current capacity of a health care organisation to deliver the programme without first undergoing health system strengthening

• d)

  Resources for EmONC scale up can be distributed evenly throughout the system in which scale up is being implemented

• e)

  One of the roles of leaders in an EmONC programme is to facilitate dialogue between healthcare providers and public policymakers

Which of the following is/are true with regard to the monitoring and evaluation of EmONC programmes that are taken to scale?

• a)

  Monitoring and evaluation is ideal but not always necessary for taking a programme to scale

• b)

  Planning to evaluate a scaled-up EmONC programme can be deferred until the programme is established

• c)

  Audit has been shown to potentially reduce perinatal mortality by up to 30%

• d)

  The process of monitoring and evaluation must involve the support of systems, facilities and individuals

• e)

  Once the stages of change have been worked through, no re-evaluation is needed

With regard to quality indicators which of the following is/are true?

• a)

  Outcome measures are more important than process measures

• b)

  Hospitals that perform best on process measures have the best risk-adjusted rates of obstetric morbidity

• c)

  Valid comparisons of clinical outcome measures between different units may require population risk adjustment

• d)

  A standardized set of quality indicators has been agreed

• e)

  Ideal clinical indicators should be measurable with routinely collected data

Regarding clinical maternity dashboards:

• a)

  Dashboards have been recommended by the RCOG for all maternity units

• b)

  Dashboards have been in use in local maternity settings since the 1990s

• c)

  Dashboards can be used to present data to stakeholders about adverse outcomes

• d)

  There is extensive data in the literature supporting maternity dashboard use and development

• e)

  Dashboards have the potential to direct targeted quality improvement initiatives

Which of the following statements is/are true regarding maternal mortality?

• a)

  The Saving Mothers reports in South Africa present data from self-selected sentinel sites which voluntarily submit data on their maternal deaths

• b)

  The Saving Mothers reports have consistently found that sub-standard care by health workers has led to many potentially avoidable maternal deaths

• c)

  Each successive Saving Mothers report has demonstrated a modest decrease in the numbers of maternal deaths in South Africa

• d)

  The decrease in maternal deaths documented in the 2011-2013 Saving Mothers report suggests that the management of obstetric emergencies such as obstetric haemorrhage has improved

• e)

  The Saving Mothers reports have recommended that all health workers in maternity units be trained in the ESMOE programme

Which of the following statements is/are true regarding ESMOE?

• a)

  ESMOE stands for: Evidence-based South African Modules for Obstetric Education

• b)

  ESMOE is a standardised training package designed specifically for the South African health sector

• c)

  It consists of various modules which incorporate standard lectures, skills demonstrations and scenarios for emergency simulation training

• d)

  The content of the ESMOE programme should be modified at each facility according to the local clinical setting

• e)

  The ESMOE “fire drill” is a module which trains staff in how to manage the situation of a fire in the labour ward

Which of the following statements is/are true further regarding ESMOE?

• a)

  It is not recommended that ESMOE be introduced to undergraduate medical or nursing curricula

• b)

  ESMOE training should include fire drills which are integrated into the day to day clinical activities of a maternity unit

• c)

  The ESMOE module on instrumental delivery has been shown to result in an increase in the instrumental delivery rate

• d)

  Adverse events reviews at a health facility can help to identify priority modules for ESMOE training in that facility

• e)

  The district clinical specialist team has a role to play in supporting and monitoring the “on-site” ESMOE training conducted by ESMOE master trainers at health facilities

At the Millennium Summit in 2000, 189 countries agreed to time-bound targets to combat poverty and underdevelopment. Which of the following statements is/are true about MDGs 4 and 5:

• a)

  MDG 4 aims to reduce under-five mortality by two thirds between 1990 and 2015

• b)

  MDG 5 targets include reducing the global maternal mortality ratio by 75%

• c)

  It is expected that targets for MDG 4 but not MDG 5 will be reached by the end of 2015

• d)

  Stillbirths in the 75 Countdown countries had declined by approximately 47% by 2012

• e)

  The greatest progress in mortality reduction has occurred in neonates

Basic newborn resuscitation is the cornerstone of newborn care in developed countries. Which of the following statements regarding basic care is/are true:

• a)

  Bag-and-mask ventilation is necessary for 15 – 20% of newborns

• b)

  Bag-and-mask ventilation should be accompanied by supplementary oxygen

• c)

  Simple stimulation interventions to initiate breathing reduce neonatal deaths

• d)

  The first five minutes of life are the most important for establishing breathing

• e)

  Simple stimulation techniques include rubbing and drying the newborn

Basic neonatal resuscitation training courses:

• a)

  Are effective in reducing neonatal deaths in facilities

• b)

  Should be followed up with refresher courses every five years

• c)

  Reduce inappropriate and harmful practices

• d)

  For traditional birth attendants (TBAs) are not effective in improving neonatal outcomes

• e)

  Are more important in community settings where advanced resuscitation is not available

The aggregate maternal case fatality rate among Caesarean section patients operated upon by non-physician mid-level providers of care (AMOs) in Tanzania is approximately

• a)

  1–2%

• b)

  5–10%

• c)

  10–15 %

• d)

  20–25%

• e)

  30–35%

A Nationwide in Mozambique at district hospital level what proportion of all Caesarean sections are carried out by non-physician mid-level providers of care (“técnicos de cirurgia”)?

• a)

  5–10%

• b)

  15–20%

• c)

  35–40%

• d)

  65–70%

• e)

  85–90%

Retention of health staff in African district hospitals is problematic and varies between medical doctors and non-physician mid-level providers of care. This was investigated in Mozambique after seven years of assignment of two categories of staff; medical doctors and “técnicos de cirurgia”. Which retention figures (%) were found?

• a)

  Medical doctors 15% and “técnicos de cirurgia” 40–50%

• b)

  Medical doctors 10% and “técnicos de cirurgia” 65–70%

• c)

  Medical doctors 0 % and “técnicos de cirurgia” 85–90%

• d)

  Medical doctors 5% and “técnicos de cirurgia” 15–20%

• e)

  Medical doctors 25% and “técnicos de cirurgia” 25–30%

Are the following statements regarding negligence claims true or false?

• a)

  Maternity claims account for the highest number of all clinical negligence claims notified to the NHSLA.

• b)

  Obstetrics and gynaecology claims account for 49% of the total value of all clinical negligence claims notified to the NHSLA.

• c)

  Less than 0.1% of births are the subject of a claim.

• d)

  There is now a £700 litigation surcharge for each baby born in England.

• e)

  An affected child may put forward a claim until its 21st birthday.

The following areas were in the top 3 categories of claims by total value from 2000–2010:

• a)

  Caesarean section

• b)

  Cerebral palsy

• c)

  Management of labour

• d)

  Antenatal investigations

• e)

  CTG interpretation

For a claim to be successful on the grounds of negligence it must be shown that:

• a)

  The standard of evidence required must be ‘beyond reasonable doubt’

• b)

  Harm was intended

• c)

  The doctor had a duty of care to the patient

• d)

  A breach in the duty of care took place

• e)

  The harm was caused as a direct result of the breach

Regarding shoulder dystocia:

• a)

  The incidence is 2%.

• b)

  The rate of PPH is 11% following shoulder dystocia, and the rate of 3/4th degree tear is 4%.

• c)

  Brachial plexus injury only occurs following vaginal delivery.

• d)

  Simulation training has been shown in some studies to improve knowledge, confidence and management of shoulder dystocia.

• e)

  Shoulder dystocia is 10 times more likely to occur in a patient with previous shoulder dystocia, compared to the general population.