Nelli Fisher

Simulation training improves medical students' learning experiences when performing real vaginal deliveries.

Objective: To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students’ performance and confidence in vaginal delivery maneuvers with and without simulation training. Methods: Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1–5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs. Results: Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 ± 3.7 versus 6.2 ± 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 ± 0.83 versus 3.00 ± 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 ± 0.94 versus 2.07 ± 1.22, respectively, P < 0.001) and week 5 (4.88 ± 0.33 versus 4.31 ± 0.63, P < 0.001) in the simulated environment. Conclusions: Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.

Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training

OBJECTIVE To determine the impact of simulation-based maternal cardiac arrest training on performance, knowledge, and confidence among Maternal-Fetal Medicine staff. STUDY DESIGN Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest simulation program. Based on evaluation of performance during initial simulations, an intervention was designed including: basic life support course, advanced cardiac life support pregnancy modification lecture, and simulation practice. Postintervention evaluative simulations were performed. All simulations included a knowledge test, confidence survey, and debriefing. A checklist with 9 pregnancy modification (maternal) and 16 critical care (25 total) tasks was used for scoring. RESULTS Postintervention scores reflected statistically significant improvement. Maternal-Fetal Medicine staff demonstrated statistically significant improvement in timely initiation of cardiopulmonary resuscitation (120 vs 32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017). CONCLUSION Prompt cardiopulmonary resuscitation initiation and pregnancy modifications application are critical in maternal and fetal survival during cardiac arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to improve skills, knowledge, and confidence in the management of this catastrophic event.

Resident training for eclampsia and magnesium toxicity management: simulation or traditional lecture?

OBJECTIVE To compare eclampsia and magnesium toxicity management among residents randomly assigned to lecture or simulation-based education. STUDY DESIGN Statified by year, residents (n = 38) were randomly assigned to 3 educational intervention groups: Simulation→Lecture, Simulation, and Lecture. Postintervention simulations were performed for all and scored using standardized lists. Maternal, fetal, eclampsia management, and magnesium toxcity scores were assigned. Mann-Whitney U, Wilcoxon rank sum and χ(2) tests were used for analysis. RESULTS Postintervention maternal (16 and 15 vs 12; P < .05) and eclampsia (19 vs 16; P < .05) scores were significantly better in simulation based compared with lecture groups. Postintervention magnesium toxcitiy and fetal scores were not different among groups. Lecture added to simulation did not lead to incremental benefit when eclampsia scores were compared between Simulation→Lecture and Simulation (19 vs 19; P = nonsignificant). CONCLUSION Simulation training is superior to traditional lecture alone for teaching crucial skills for the optimal management of both eclampsia and magnesium toxicity, 2 life-threatening obstetric emergencies.

Clinical Correlates of Posterior Reversible Encephalopathy Syndrome in Pregnancy.

The authors aimed to determine whether clinical findings of preeclampsia predict magnetic resonance imaging (MRI) diagnosis of posterior reversible encephalopathy syndrome (PRES). The course among preeclamptics/eclamptics with clinically suspected PRES with vs without MRI diagnosis of PRES was compared. Of 46 patients who underwent MRI (eight eclamptics, 38 preeclamptics), five eclamptics (62.5%) and four preeclamptics (10.5%) had confirmed PRES (P=.004). Patients with PRES were younger (26 years vs 31 years, P=.008) and had a higher prevalence of thrombocytopenia (33% vs 8%, P=.04), a greater prevalence of proteinuria (100% vs 61%, P=.04), and higher peak systolic and diastolic blood pressures (P<.05). As opposed to findings from previous reports, PRES was not seen uniformly among eclamptic women and was found in 10.5% of preeclamptics with clinical suspicion of PRES in this study. Given that no single or set of findings were reliable predictors of PRES, consideration for rigorous management of hypertension should be applied to all patients with preeclampsia and eclampsia.

Predictors of posterior reversible encephalopathy syndrome in preeclampsia and eclampsia.

INTRODUCTION: To determine whether clinical findings among women with preeclampsia or eclampsia predict the magnetic resonance imaging (MRI) diagnosis of posterior reversible encephalopathy syndrome and to determine whether posterior reversible encephalopathy syndrome is found in all patients with eclampsia or among patients with preeclampsia. METHODS: We performed a retrospective review of women (2007–2012) who had MRIs because of preeclampsia, which was severe or associated with neurologic findings, or because of eclampsia. Comparisons were made between the clinical course of patients with and without an MRI diagnosis of posterior reversible encephalopathy syndrome. Magnetic resonance images were reviewed by two independent blinded neuroradiologists. RESULTS: Forty-six patients had MRIs (38 preeclamptics, eight eclamptics). In five of eight (62.5%) eclamptics and 4 of 38 (11%) preeclamptics, posterior reversible encephalopathy syndrome was confirmed (P=.004). Patients with posterior reversible encephalopathy syndrome were younger (P=.00), had a higher prevalence of thrombocytopenia (P=.048) and higher systolic and diastolic pressures at delivery and postpartum (P<.05). Race, gestational age, parity, mode of delivery, chronic hypertension, neurologic symptoms, medications, and body mass index did not differ between groups. CONCLUSIONS: As opposed to previous reports, we found that posterior reversible encephalopathy syndrome was not uniformly found among eclamptic women and was found in over 10% of women with severe preeclampsia. Predictors of posterior reversible encephalopathy syndrome were younger age, higher systolic and diastolic blood pressures, eclampsia, and lower platelets. Given that no single finding or set of findings was completely reliable predictors of posterior reversible encephalopathy syndrome, consideration may have to be given to more liberal recourse to MRI. Alternatively, more rigorous management of hypertension, as is currently recommended for patients with posterior reversible encephalopathy syndrome, should be applied to all women with severe preeclampsia or eclampsia.

The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial.

Abstract Aims: The effect of positive vs. negative comments (praise vs. criticism) on trainees’ subsequent cognitive and technical performance is unknown, but of potential importance. We performed a randomized trial of giving either praise or criticism during simulated normal vaginal deliveries (using a high-fidelity birthing simulator) to assess the differential effect of these types of comments on students’ cognitive and technical performance, and perceived confidence after their learning experience. Methods: Medical and nursing students underwent stratified randomization to praise or criticism. Students (n=59) initially participated in a teaching demonstration and practiced normal spontaneous vaginal delivery using a birthing simulator. A baseline assessment of cognitive and technical skills, and of self-confidence, was followed by a second simulation during which positive or negative comments were given using standardized scripts. Cognitive performance, technical performance and confidence measures were then scored again. Results: Cognitive and technical performance scores in the “praise” group improved significantly by 2.5 (P=0.007) and 1.8 (P=0.032), respectively, while those in the “criticism” group remained unchanged. The self-reported confidence scores did not show any significant change from baseline in either group. Conclusions: Praise strengthens students’ cognitive and technical performances, while criticism does not.