GOMOMS: How to initiate an OB drills Simulation Program

Determine the following:

Why, Who What and Where

 WHY

WHY are you interested in starting a program?

This is a crucial step.  Take the time to carefully consider what are your goals. 

Major uses of simulation that have been shown to be an effective tool to improve patient care:

1.     Residency training

2.     Labor and delivery (LD) team training

3.     To uncover system errors and improve workflow in your unit. 

WHO

The WHO encompasses not only the trainees but also hospital stakeholders* who should be included to assure the program is tailored to the needs of your hospital.

Trainees – will be determined by the WHY

1.     Resident training: Ob/Gyn residents at all levels. When indicated include LD nurses to enhance communication skills.

2.     Labor and delivery team training: LD teams should have representation from the main specialties on the unit- OB, LD nursing, Anesthesia and Pediatrics when needed.

3.     System errors: LD teams and other indicated staff.  An example would be including blood bank personnel when practicing massive transfusion protocols

* Hospital stakeholders- examples

1.     Quality improvement committee

2.     Risk management

3.     Education Committees

WHAT

WHAT simulations are you performing?

There are a variety of ways to determine your scenario subject matter. The WHY and WHO of your program will dictate the subject matter.

(Of note, not all events are amenable to simulation technique)

Possible considerations include:

1.     Recreation of actual events on from your unit

2.     Creation of scenarios based on sentinel events/ law suits/ RCAs from your institution

3.     Use of national data of malpractice suits. 

WHERE

The options include: 

1.     In situ (in Labor and Delivery) 

                                              i.     Most realistic site

                                            ii.     Can uncover system issues and improve work flow

                                          iii.     Simulation may be canceled due to patient care

2.     Classroom

                                              i.     Undisturbed time but unrealistic setting

3.     Simulation center

Creation of the Simulation Scenario

Outline for a Simulation Scenario:

1.     Learning objectives

2.     Roles for team members

3.     Equipment

4.     Prebrief

5.     Scenario script

6.     Debriefing points

1.     Learning objectives

      Scenario creation should begin with identification of the learning objectives for the       trainees.

      CAUTION: do not try to accomplish more than 3-4 major learning objectives with one       scenario.

2.     Roles for the team.  Each simulation team member should be assigned a Role before the simulation to minimize confusion.

3.     Equipment needed for the scenario.

4.     Prebrief- discussion emphasizing that Simulation is a training technique and not an evaluation tool. Assurance of confidentiality from both team members and trainees should be emphasized allowing the creation of the “safe zone”.

5.     Scenario script should remain simple and reflect the learning objective.

6.     Debriefing points based on the learning objectives can be listed to assist with the discussion.