DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162661

Effectiveness of simulation technique in teaching-learning process for prevention of postpartum hemorrhage in obstetrics and gynecology

Naina Kumar, Swanand S. Pathak, Namit Kant Singh, Samar Rudra

Abstract


Background: Simulation involves creation of artificial depiction of clinical situations which are rarely encountered. Objectives of the study to evaluate efficacy of simulation in teaching learning process for prevention of postpartum hemorrhage amongst postgraduates of Obstetrics Gynecology department.

Methods: Prospective study was conducted in Obstetrics Gynecology department of rural tertiary centre of Northern India over 6 months. Twenty one postgraduates of Obstetrics Gynecology department were randomly assigned to either simulation teaching using mannequin / didactic lecture on Active Management of Third Stage of Labor, ten students in each group (one dropped out). Efficacy of each teaching learning method was compared using multiple choice questionnaires: pre-teaching, post-teaching, Direct Observation of Procedural Skills (DOPS) encounter using structured checklist. Student satisfaction was evaluated using feedback questionnaire. Statistical analysis was done by Mann-Whitney test using SPSS-20 software.

Results: Both groups showed no difference in performance of pretest MCQ. Comparison of DOPS performance showed, significant difference (p=0.0003) between simulation and didactic lecture group (mean marks 5.20±0.79 in Group 1 and 3.20±1.63 in Group 2). Both groups demonstrated significant improvement in post-teaching, but on comparison of post-test MCQ with pretest marks, significant difference was noted with mean difference of 7.80±1.76 in Group 1, 3.60±1.98 in Group 2, with greater improvement observed among simulation group. Students ranked simulation higher with regard to enjoyment (80%), interest (75%), relevance (75%), understanding (70%) and accessibility to ask questions (80%).

Conclusions: Simulation based teaching is better than didactic lecture as teaching learning modality especially for critical care procedures.


Keywords


Didactic lecture, Medical education, Postpartum hemorrhage, Simulation-based teaching, Teaching-learning modality

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References


Rath WH. Postpartum hemorrhage: update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand. 2011;90(5):421-8.

World Health Organization, authors. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva (Switzerland): WHO; 2007.

Khan KS, Wojdyla D, Say L, Gulmezogh AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. The Lancet 2006;367:1066-1074.

Carroli G, Cuesta C, Abalos E. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999-1012.

Calvert C, Thomas SL, Ronsmans C. Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PLoS One. 2012;7(7):e41114.

Berg CJ1, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005;106(6):1228-34.

Kilpatrick SJ, Prentice P, Jones RL, Geller S. Reducing maternal deaths through state maternal mortality review. J Womens Health (Larchmt). 2012;21(9):905-9.

Della Torre M, Kilpatrick SJ, Hibbard JU, Simonson L, Scott S, Koch A, et al. Assessing preventability for obstetric hemorrhage. Am J Perinatol. 2011;28(10):753-60.

Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2000;(2):CD000007. Review. Update in: Cochrane Database Syst Rev. 2000;(3):CD000007.

International Confederation of Midwives, International Federation of Gynaecology and Obstetrics. Joint statement management of the third stage of labour to prevent postpartum haemorrhage. The Hague: ICM; London: FIGO; 2003. Available at:http://www.internationalmidwives.org/modules/ContentExpress/img_repository/final%20joint%20statement%20active%20manangement-eng%20with%20logo.pdf or http://www.figo.org/content/PDF/PPH%20Joint%20Statement.pdf. Accessed on October 12, 2006.

Kongnyuy EJ, Mlava G, van den Broek N. 'Using Criteria-Based Audit to Improve the Management of Postpartum Haemorrhage in Resource Limited Countries: a case study of malawi', Matern Child Health J. 2009;13(6):873-8.

Ogden PE, Cobbs LS, Howell MR, Sibbitt SJ, DiPette DJ. Clinical simulation: importance to the internal medicine educational mission. Am J Med. 2007;120(9):820-4.

Grenvik A, Schaefer JJ, DeVita MA, Rogers P. New aspects on critical care medicine training. Curr Opin Crit Care. 2004;10(4):233-7.

Wragg A, Wade W, Fuller G, Cowan G, Mills P. Assessing the performance of specialist registrars. Clin Med (Lond). 2003;3(2):131-4.

David C, Dianne D. The essential 20: twenty components of 237 an excellent health care team. Rose Dog Books. 2009:25-40.

Hossein N, Abdus S. The effect of power point presentations on student learning and attitudes. Global Perspect. Acc Educ. 2005;2:53-73.

Chacko TV. Moving toward competency-based education: Challenges and the way forward. Arch Med Health Sci. 2014;2:247-53. Available at: http://www.amhsjournal.org/text.asp?2014/2/2/247/144365.

Ramsingh D, Alexander B, Le K, Williams W, Canales C, Cannesson M. Comparison of the didactic lecture with the simulation/model approach for the teaching of a novel perioperative ultrasound curriculum to anesthesiology residents. J Clin Anesth. 2014;26(6):443-54.

Daniels K, Arafeh J, Clark A, Waller S, Druzin M, Chueh J. Prospective randomized trial of simulation versus didactic teaching for obstetrical emergencies. Simul Healthc. 2010;5(1):40-5.

Hallikainen J, Väisänen O, Randell T, Tarkkila P, Rosenberg PH, Niemi-Murola L. Teaching anaesthesia induction to medical students: comparison between full-scale simulation and supervised teaching in the operating theatre. Eur J Anaesthesiol. 2009;26(2):101-4.

Morgan PJ, Cleave-Hogg D, McIlroy J, Devitt JH. Simulation technology: a comparison of experiential and visual learning for undergraduate medical students. Anesthesiology. 2002;96(1):10-6.

Tan GM, Ti LK, Tan K, Lee T. A comparison of screen-based simulation and conventional lectures for undergraduate teaching of crisis management. Anaesth Intensive Care. 2008;36(4):565-9.

Wang CL, Schopp JG, Petscavage JM, Paladin AM, Richardson ML, Bush WH. Prospective randomized comparison of standard didactic lecture versus high-fidelity simulation for radiology resident contrast reaction management training. Am J Roentgenol. 2011;196(6):1288-95.

Solymos O, O'Kelly P, Walshe CM. Pilot study comparing simulation-based and didactic lecture-based critical care teaching for final-year medical students. BMC Anesthesiol. 2015;15:153.

Paskins Z, Peile E. Final year medical students' views on simulation-based teaching: a comparison with the best evidence medical education systematic review. Med Teach. 2010;32(7):569-77.

Okuda Y, Bryson EO, DeMaria S Jr. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med. 2009;76(4):330-43.