GO MOMS Nicaragua Project Abstract

1. SIMULATION-BASED TRAINING OF OBSTETRIC PROVIDERS
IN NICARAGUA
Kay Daniels MD1
, Antonia Nicosia MD2
, Shauna Brodie RN,NP3
, Jolyn Chen MD2
,
Maria Auxiliadora Baca MD4
, Maurice Druzin MD1
1
Dept of Obstetrics and Gynecology Stanford Health Care, 2
Kaiser Permanent Hospital
3
University of California San Francisco, Stanford University School of Medicine,
4
Hospital Esquela Oscar Danilo Rosales Arguello, Leon, NIcaragua
BACKGROUND METHODS
FINDINGS
INTERPERTATION
This project validates that SBT can be
successfully introduced to low resource
areas. Although SBT originated in the
developed world, its use is perhaps more
applicable in the developing world where
literacy and educational levels vary.
Importantly simulation does not require
expensive resources beyond the human
capital to facilitate the scenarios.
As stated by one of the Nicaraguan faculty
members “Sometimes we talk about what
we do in emergencies… but it stops there.
You can know the text, but in the moment
when you’re doing it, for reasons of fear, or
time pressure, you forget it. When you have
had simulation experiences, you learn how
to do it well the first time and now, you will
do it that way forever.”
We conducted 3 in country visits:
Visit 1: Needs Assessment
Visit 2: Training of HEODRA faculty to perform
simulation based teaching for:
a)Postpartum hemorrhage
b)Active management of the third stage of
labor
c)Preeclampsia/eclampsia management
d)Shoulder dystocia
e)In situ labor and delivery simulation
Visit 3: Observation of HEODRA faculty
performing simulation courses by researchers
A post event survey was sent out to all
participating HEODRA faculty after 6 months
“The vast majority of maternal deaths
are avoidable. The presence of a trained
health-care worker during delivery is
crucial in reducing maternal deaths.” *
Studies in the developed world have
demonstrated improved patient outcome
after simulation-based training (SBT).
The goal of this project was to train
educators in a low resource environment
to implement and sustain a SBT program
for obstetrical emergencies.
Nicaragua is the second poorest country
in the Western hemisphere with a
maternal mortality of 95/100,000 births in
comparison with the USA rate of
17/100,000 births. The institution chosen
for this study was Hospital Escuela Oscar
Danilo Rosales Arguello (HEODRA) a
public teaching hospital that performs
>5000 deliveries a year. The training
program participants consisted of 28
residents and 21 faculty.
At visit #3 HEODRA faculty were observed to
successfully incorporate SBT in to their teaching
curriculum
6 month post course survey results revealed
improved self efficacy and a change in practice:
1)17 of 22 reported a change in their practice
after participating in the program
2) 5 of 22 have now placed a B lynch
compression suture
3)17/22 felt more confident about placing a B
lynch compression suture
4)All faculty stated they felt comfortable using
simulation for teaching
* Millennium Development Goals 2011