Improving shoulder dystocia management among resident and attending physicians using simulations

Am J Obstet Gynecol. 2008 Sep;199(3):294.e1-5. doi: 10.1016/j.ajog.2008.05.023. Epub 2008 Jul 17.


Objective: The objective of the study was to determine whether a simulation-based educational program would improve residents' and attending physicians' performance in a simulated shoulder dystocia.

Study design: Seventy-one obstetricians participated in an unanticipated simulated shoulder dystocia, an educational debriefing session, and a subsequent shoulder dystocia simulation. Each simulation was scored, based on standardized checklists for 4 technical maneuvers and 6 communication tasks, by 2 physician observers. Paired Student t tests were used for analysis.

Results: Forty-three attendings and 28 residents participated. Residents showed significant improvement in mean maneuver (3.3 +/- 0.9 vs 3.9 +/- 0.4, P = .001) and communication (3.5 +/- 1.2 vs 4.9 +/- 1.0, P < .0001) scores after simulation training. Attending physicians' communication (3.6 +/- 1.6 vs 4.9 +/- 1.1, P < .0001) scores were significantly improved after training.

Conclusion: Our program improved physician performance in the management of simulated shoulder dystocia deliveries. Obstetric emergency simulation training can improve physicians' communication skills, at all levels of training, and should be incorporated into labor and delivery quality improvement measures.

MeSH terms

  • Adult
  • Clinical Competence*
  • Delivery, Obstetric / education*
  • Dystocia / therapy*
  • Female
  • Humans
  • Internship and Residency
  • Medical Staff, Hospital
  • Obstetrics / education*
  • Pregnancy
  • Shoulder