ABSTRACT #55

RAPID CYCLE DELIBERATE PRACTICE VS TRADITIONAL CASE-BASED SIMULATION FOR TEACHING EMERGENCY MEDICINE PHYSICIANS COMPLICATED OBSTETRIC DELIVERIES

Eleanor R. Aluise, Jared Kutzin, Christopher Strother

PURPOSE AND GOALS: High-risk obstetric deliveries in the Emergency Department (shoulder dystocia and breech deliveries) are a rare but high-stakes occurrence that all Emergency Providers must be prepared for. These complications pose threats of both morbidity and mortality to mother and infant. Given the rarity of these clinical presentations, simulation education is a potentially powerful tool in teaching and maintaining these skills. Classically, simulation education is case-based. In recent years, Rapid Cycle Deliberate Practice (RCDP) has been popularized as an alternative simulation method for learning procedural skills. Some studies have shown improved learning with this technique, while others have not. There have been no studies to date that can compare the effectiveness of these two strategies in teaching EM providers management of high-risk obstetric deliveries.

METHODS: This is a prospective multi-site cohort study comparing educational outcomes of the RCDP group to those of the case-based group. Educational outcomes include objective knowledge of managing shoulder dystocia and breech delivery as well as self-assessed confidence levels.

Eighteen participants took part in the study. Groups were comprised of similar members (EM faculty, residents, and PAs) using a between-subjects experimental design, based on clinical site. The RCDP group (N=10) used a birthing manikin task trainer while the case-based group (N=8) used high-fidelity manikin and standard scenario-debriefing training. Pre- and post- multiple-choice knowledge assessments were obtained from participants. Within-group data was analyzed using Wilcoxon sign-rank test, and between-group analysis was completed using Analysis of Covariance (ANCOVA).

EVALUATION PLAN: Evaluation of the simulation curriculum includes the post-intervention knowledge assessment to assess learning outcomes and confidence levels. Additionally it includes fields for participant feedback about the curriculum to assess their perceived utility and opportunities for feedback for future iterations.

SUMMARY OF RESULTS: In both groups, knowledge and confidence significantly increased after intervention (p<0.05). However, after adjusting for pre-intervention scores, the case-based group experienced a significant larger jump in knowledge level than the RCDP group (p = 0.045). There was no difference in the post-intervention confidence score between the two groups (p = 0.35).

REFLECTIVE CRITIQUE: This was a fun project to implement as participants were largely invested and engaged in the material. We didn’t get nearly as many participants as we had hoped, partly due to some recruitement errors. Some sessions were completed on-shift, which meant learners’ focus was divided between the simulation and patients.

While the classic case seems to be better for pure knowledge aquisition in this study, RCDP was still effective. It is encouraging to see that both methods are effective, and educators may select whichever works better with schedule, space, and material limitations.