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Tim Draycott - One of the best experts on this subject based on the ideXlab platform.
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fetal head position and perineal distension associated with the use of the bd odon device in operative vaginal birth a simulation study
British Journal of Obstetrics and Gynaecology, 2017Co-Authors: Stephen Obrien, Cathy Winter, Christy Burden, Michel Boulvain, Tim Draycott, Joanna F CroftsAbstract:Objective To investigate (1) the placement of the BD Odon Device on the model fetal head and (2) perineal distention during simulated operative vaginal births conducted with the BD Odon Device. Design Observational simulation study. Setting North Bristol NHS Trust, UK. Population or sample Four hundred and forty simulated operative vaginal births. Methods Three bespoke fetal Mannequins were developed to represent (1) bi-parietal diameter of the 50th centile at term, (2) bi-parietal diameter at the 5th centile at term, and (3) 50th centile head with 2 cm of caput. Siting of the BD Odon Device on model heads was determined before and after 400 simulated operative vaginal births. Variables were analysed to determine their effect on device siting and movement during birth. The fetal Mannequins were placed inside a maternal Mannequin and the BD Odon Device was placed around the fetal head as per the instructions for use. The location of the air cuff was determined before and after the head was delivered. Perineal distension was determined by recording maximum perineal distention during a simulated operative vaginal birth using the same procedure, as well as scenarios employing an inappropriately non-deflated air cuff (for the BD Odon Device), the Kiwi ventouse and non-rotational forceps. Main outcome measures Site and displacement during birth of the BD Odon Device on a model head. Maximal perineal distension during birth. Results The BD Odon Device was reliably sited in a standard over the fetal head position (approximately 40 mm above the fetal chin) for all stations, head sizes and positions with no significant displacement. In occipito-posterior births, compared with occipito-anterior or transverse, the BD Odon Device routinely sited further down the fetal head (toward the chin). The BD Odon Device was not associated with more perineal distension compared with forceps or Kiwi ventouse (respectively 21, 26 and 21 mm at posterior fourchette). Conclusions The BD Odon Device reliably sited over a safe area of the fetal head in 400 simulated births representative of clinical practice. The BD Odon Device generates similar levels of perineal distension compared with Kiwi ventouse when used correctly. Tweetable abstract Location of the BD Odon Device on a fetal head in simulation.
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Robert Fox, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional lowfidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05–20.81; P.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. (Obstet Gynecol 2006;108:1477–85)
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional low-fidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.
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shoulder dystocia training using a new birth training Mannequin
British Journal of Obstetrics and Gynaecology, 2005Co-Authors: Joanna F Crofts, Georgios Attilakos, Mike Read, Thabani Sibanda, Tim DraycottAbstract:Shoulder dystocia 'skill drills' are a requirement for the Maternity CNST standards. However, there is, as yet, no evidence that training in the management of shoulder dystocia improves outcome. We developed a Mannequin for training and investigated its effectiveness. The management of shoulder dystocia improved following training with the Mannequin. There was a reduction in the head-to-body delivery duration, and the maximum applied delivery force, following training; however, these did not reach statistical significance. After training no subject applied a delivery force of greater than 100 N, a level above which fetal injury has been shown to occur.
Joanna F Crofts - One of the best experts on this subject based on the ideXlab platform.
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fetal head position and perineal distension associated with the use of the bd odon device in operative vaginal birth a simulation study
British Journal of Obstetrics and Gynaecology, 2017Co-Authors: Stephen Obrien, Cathy Winter, Christy Burden, Michel Boulvain, Tim Draycott, Joanna F CroftsAbstract:Objective To investigate (1) the placement of the BD Odon Device on the model fetal head and (2) perineal distention during simulated operative vaginal births conducted with the BD Odon Device. Design Observational simulation study. Setting North Bristol NHS Trust, UK. Population or sample Four hundred and forty simulated operative vaginal births. Methods Three bespoke fetal Mannequins were developed to represent (1) bi-parietal diameter of the 50th centile at term, (2) bi-parietal diameter at the 5th centile at term, and (3) 50th centile head with 2 cm of caput. Siting of the BD Odon Device on model heads was determined before and after 400 simulated operative vaginal births. Variables were analysed to determine their effect on device siting and movement during birth. The fetal Mannequins were placed inside a maternal Mannequin and the BD Odon Device was placed around the fetal head as per the instructions for use. The location of the air cuff was determined before and after the head was delivered. Perineal distension was determined by recording maximum perineal distention during a simulated operative vaginal birth using the same procedure, as well as scenarios employing an inappropriately non-deflated air cuff (for the BD Odon Device), the Kiwi ventouse and non-rotational forceps. Main outcome measures Site and displacement during birth of the BD Odon Device on a model head. Maximal perineal distension during birth. Results The BD Odon Device was reliably sited in a standard over the fetal head position (approximately 40 mm above the fetal chin) for all stations, head sizes and positions with no significant displacement. In occipito-posterior births, compared with occipito-anterior or transverse, the BD Odon Device routinely sited further down the fetal head (toward the chin). The BD Odon Device was not associated with more perineal distension compared with forceps or Kiwi ventouse (respectively 21, 26 and 21 mm at posterior fourchette). Conclusions The BD Odon Device reliably sited over a safe area of the fetal head in 400 simulated births representative of clinical practice. The BD Odon Device generates similar levels of perineal distension compared with Kiwi ventouse when used correctly. Tweetable abstract Location of the BD Odon Device on a fetal head in simulation.
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Robert Fox, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional lowfidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05–20.81; P.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. (Obstet Gynecol 2006;108:1477–85)
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional low-fidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.
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shoulder dystocia training using a new birth training Mannequin
British Journal of Obstetrics and Gynaecology, 2005Co-Authors: Joanna F Crofts, Georgios Attilakos, Mike Read, Thabani Sibanda, Tim DraycottAbstract:Shoulder dystocia 'skill drills' are a requirement for the Maternity CNST standards. However, there is, as yet, no evidence that training in the management of shoulder dystocia improves outcome. We developed a Mannequin for training and investigated its effectiveness. The management of shoulder dystocia improved following training with the Mannequin. There was a reduction in the head-to-body delivery duration, and the maximum applied delivery force, following training; however, these did not reach statistical significance. After training no subject applied a delivery force of greater than 100 N, a level above which fetal injury has been shown to occur.
Linda P Hunt - One of the best experts on this subject based on the ideXlab platform.
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Robert Fox, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional lowfidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05–20.81; P.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. (Obstet Gynecol 2006;108:1477–85)
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional low-fidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.
Denise Ellis - One of the best experts on this subject based on the ideXlab platform.
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Robert Fox, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional lowfidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05–20.81; P.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. (Obstet Gynecol 2006;108:1477–85)
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional low-fidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.
Christine Bartlett - One of the best experts on this subject based on the ideXlab platform.
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Robert Fox, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional lowfidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05–20.81; P.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. (Obstet Gynecol 2006;108:1477–85)
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training for shoulder dystocia a trial of simulation using low fidelity and high fidelity Mannequins
Obstetrics & Gynecology, 2006Co-Authors: Joanna F Crofts, Christine Bartlett, Denise Ellis, Linda P Hunt, Tim DraycottAbstract:OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity Mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training Mannequin (incorporating force perception training) or traditional low-fidelity Mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity Mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with Mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity Mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.
