Simulation-based crisis team training for multidisciplinary obstetric providers

Abstract

Background: The use of team training programs is promising with regards to their ability to impact knowledge, attitudes, and behavior about team skills. The purpose of this study was to evaluate a simulation-based team training program called Obstetric Crisis Team Training Program (OBCTT) (based on the original training program of Crisis Team Training) framed within a multilevel team theoretical model. We hypothesized that participation in OBCTT would positively impact 10 variables: individual's knowledge (about team process and obstetric emergency care); confidence and competence in handling obstetric emergencies; and participant attitudes (toward the utility of a rapid response team, simulation technology as a teaching methodology, the utility of team skills in the workplace, comfort in assuming team roles; and individual and team performance). Improvement of objectively measured team performance in a simulated environment was also assessed.

Methods: Twenty-two perinatal health care professionals (attending physicians, nurses, resident, and nurse midwives) volunteered to participate in this pretest-posttest study design. All participants were given an online module to study before attending a 4-hour training session. Training consisted of participation in four standardized, simulated crisis scenarios with a female birthing simulator mannequin. Team simulations were video recorded. Debriefings were conducted after each simulation by having team members review the video and discuss team behaviors and member skills. Self-report measures of perinatal and team knowledge as well as several attitude surveys were given at the beginning and again at the end of the training session. A postsimulation attitude survey was administered immediately after the first and last simulation, and a course reaction survey was administered at the end of the training program. Objective task completion scores were computed after each simulation to assess performance.

Results: There were significant (P<0.004) improvements in three of the outcome variables, after controlling for type I error with Bonferroni's correction; attitudes toward competence in handling obstetric emergencies (t=1.6), as well as individual (t=4.2), and team performance (t=4.1). The remaining 6 variables, attitude toward simulation technology, attitude toward the rapid response team; confidence in handling obstetric emergencies; utility of team skills in the workplace; comfort in assuming various team roles; and knowledge, were not statistically significant. Overall task completion from the first to the last simulation (XF, df=3, n=3, 8.2, P=0.042) substantially improved (P<0.05).

Conclusion: The crisis team training model is applicable to obstetric emergencies. Trainees exhibit a positive change in attitude; perception of individual and team performance, and overall team performance in a simulated environment. The ability of individuals to accurately assess their performance improved as a result of training.