Page 224 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F7.2 Committed and Happy Staff 13:15 Room 421

Randomised Controlled Study to Assess Skill Retention at Six versus 12 Months after Simulation Training in
Shoulder Dystocia
Lee MHM, Chan CN, Ma TWL
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong

Introduction
Shoulder dystocia is a relatively uncommon (0.2-3% of all deliveries) but serious obstetrics emergency which can lead to
severe morbidity and mortality to the delivering fetus. Current evidence suggests that annual training is adequate to maintain
skills for management of shoulder dystocia.

Objectives
To test our hypothesis that skills start to decline at six months and further decline to 12 months after training.

Methodology
In this randomised single-blinded study, 12 obstetricians and 42 midwives of our department were randomly assigned to
attend a one-hour lecture with mixed simulation session on shoulder dystocia in the simulation centre of our hospital at
month ‘0’ (group two) or month ‘6’ (group one). Their knowledge score and primary outcome were assessed before and
immediately after the training, and subsequently retested at month ‘12’. Time taken to complete the simulation scenario
(secondary outcome) was similarly assessed. Subgroup analysis was also performed after separating the data into doctors
only and midwives only.

Results
Compared to pre-training, the drill score increased immediately after (or at-) the simulation training in both group one (8.26
vs 14.26, p<0.001) and group two (9.46 vs 14.69, p< 0.001), but decreased at six months post-training in group one (14.26 vs
11.54, p<0.001) and at 12 months post-training in group two (14.69 vs 11.54, p< 0.001), though to a level which was still better
before the training. There was no difference in the decline in score from at-training to post -training between group one and
group two (-2.63 vs -2.81, p=0.790). Similar trend was found regarding time required to complete the simulated scenario.
Subgroup analysis was performed separately for obstetricians and midwives where similar trends were found.
Conclusion
The study demonstrated that simulation training results in immediate improvement in shoulder dystocia management,
however knowledge degrades over time. Ongoing training is suggested at a minimum of 12 months interval but ideally at six
months interval for both doctors and midwives.

Wednesday, 17 May

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