Abstract
Objective
Simulation is increasingly valued as a learning tool in obstetrical practice. In situ
simulation assesses the hands-on and critical thinking skills of a health care team
within their clinical setting. We aimed to create an in situ simulation program to
promote skills acquisition, enhance teamwork, and identify system limitations.
Methods
Key obstetrical emergencies were identified through a needs assessment. In situ simulations
were developed to address these clinical presentations. During simulations, organizers
and participants identified latent safety threats. Medical management was evaluated
through comprehensive emergency-specific checklists. Leadership attitudes were assessed
using the modified Perinatal Emergency Team Response Assessment tool. Following each
simulation, team members were debriefed, and qualitative and quantitative feedback
was solicited and aggregated by specialty and discipline.
Results
Simulations were conducted monthly at two academic centers over 14 months. Participation
was interdisciplinary, including learners, staff physicians, nursing, and allied health
team members from the departments of obstetrics, anesthesia, emergency medicine, and
neonatology. Participants reported their involvement was enjoyable. Participants reported
improvements in communication skills, content knowledge, and procedural knowledge.
Participants favourably rated the spontaneity of simulations, clinically relevant
scenarios, safe environment, and use of realistic equipment. Latent safety threats,
related to equipment, medication, personnel, resources, and technical skills, were
identified.
Conclusion
We present the successful implementation of a comprehensive in situ simulation program.
In situ simulation allows for deliberate practice of obstetrical emergencies and promotes
a culture of patient safety. Lessons learned provide valuable data to identify limitations
within our current practices and inform future policy change.
Résumé
Objectif
La simulation est de plus en plus prisée comme outil d'apprentissage dans le cadre
de la pratique obstétricale. La simulation sur place évalue les compétences pratiques
et de réflexion critique d'une équipe de soins de santé dans son milieu clinique.
Notre objectif consistait à créer un programme de simulation sur place visant à promouvoir
l'acquisition de compétences, à améliorer le travail d’équipe et à déterminer les
limites du système.
Méthodologie
Les principales urgences obstétricales ont été déterminées au moyen d'une évaluation
des besoins. Des simulations sur place ont été élaborées pour aborder ces tableaux
cliniques. Au cours des simulations, les organisateurs et les participants ont cerné
les menaces latentes pour la sécurité. La prise en charge médicale a été évaluée au
moyen de listes de contrôle exhaustives spécifiques aux situations d'urgence. Les
attitudes de leadership ont été évaluées à l'aide de l'outil modifié d’évaluation
d'une équipe d'intervention en cas d'urgence périnatale (Perinatal Emergency Team Response Assesment). Après chaque simulation, les membres de l’équipe ont été débreffés; des commentaires
tant qualitatifs que quantitatifs ont été sollicités et réunis par spécialisation
et discipline.
Résultats
Des simulations ont été effectuées chaque mois dans deux centres universitaires sur
14 mois. La participation était interdisciplinaire et impliquait les départements
d'obstétrique, d'anesthésie, de médecine d'urgence et de néonatologie, notamment des
apprenants, des médecins membres du personnel, des infirmières et des membres des
équipes de professionnels paramédicaux. Les participants ont indiqué avoir trouvé
l'expérience agréable. Les participants ont signalé une amélioration de leurs compétences
en communication, de leurs connaissances sur le contenu et de leurs connaissances
procédurales. Les participants ont évalué favorablement la spontanéité des simulations,
les scénarios cliniquement pertinents, le milieu sûr et l'utilisation d’équipement
réaliste. Des menaces latentes pour la sécurité, liées à l’équipement, aux médicaments,
au personnel, aux ressources et aux compétences techniques, ont été constatées.
Conclusion
Nous présentons la mise en œuvre réussie d'un programme complet de simulation sur
place. La simulation sur place permet une prise en charge délibérée des patientes
en situation d'urgences obstétricales et favorise une culture qui assure leur sécurité.
Les leçons tirées fournissent des données précieuses pour déterminer les limites de
nos pratiques actuelles et orienter de futurs changements de politiques.
Keywords
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Article info
Publication history
Published online: March 11, 2020
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
