Master Class

Technology Offers a Way to Practice Critical Skills


Soon-to-be-published research that we have recently completed at Georgetown University and the Washington Hospital Center similarly indicates that obstetricians generally should strive for continuing simulation training at least once a year. Residents in our study who were initially taught on the simulator scored higher when tested a year later than did residents who received no simulation training. Overall, however, everyone's scores declined.

Obstetric simulation is part of our future. New physicians of the future will enter practice having done simulation training in a variety of high-acuity, low-frequency scenarios—rather than learning solely through lectures and impromptu teaching after events have occurred—and those of us already in practice will likely find that working occasionally with low-fidelity mannequins enables us to provide better, safer patient care while reducing our liability risk.

Dr. Marsha Solomon, chief resident at the Washington Hospital Center, is shown performing a simulated forceps delivery in the photo at left. In the photo at right, Dr. Solomon performs a simulated breech vaginal delivery. Photos courtesy Dr. Tamika C. Auguste

Obstetric Simulation

Do you think that you would like to have your next airplane flight piloted by someone who has not flown a plane in several years or who has little experience in landing?

Pilots are among the professionals who gain their greatest experience and expertise through the development of skills using various simulation technologies.

Simulation training is common in the aviation industry, as it is in aeronautics and in some branches of engineering, which makes this question significantly less worrisome and less relevant than if simulation were not common.

Medicine in general—and obstetrics in particular—has been practiced worldwide using the apprenticeship model, in which residents and interns work with attending physicians to learn the art of medicine.

While caring for patients with various disorders and in various scenarios, physicians-in-training work alongside the more senior practitioners, taking on progressive amounts of responsibility. Experience is gained accordingly.

This approach has been very successful over the years, and will remain so. It may be enhanced, however, as the simulation approach is slowly integrated into medicine and into obstetrics training.

The use of simulation training in medicine makes intuitive sense. The acquisition of the greatest possible skill or expertise—or the enhancement of skills if there is a hiatus in practice—makes sense from quality-of-care and patient-safety perspectives, and also because of the litigious environment in which we live and practice.

The question, “How would you like to have your baby delivered by an obstetrician who has not used forceps or managed shoulder dystocia in over a year?” is a valid one for patients who realize that less-common delivery scenarios are unpredictable.

This month's Master Class will focus on the utility, practicability, and application of simulation technology in obstetrics as a means of maximizing not only the skills of the resident, but also the skills of the practicing clinician.

Our guest author, Dr. Tamika C. Auguste, is the director of obstetric simulation at Washington Hospital Center and assistant professor of obstetrics/gynecology at Georgetown University in Washington. She speaks in various forums on the issue of simulation for both residents and practicing physicians, and is fast becoming a young leader and expert from whom we can expect to hear more in the future.

Key Points on Simulation

1. Simulation can be used to practice classic obstetric skills and high-risk, low-frequency obstetric emergencies.

2. Simulation is not only for those in academic medicine but also for those in private practice.

3. Low-fidelity simulators can be just as useful as high-fidelity simulators.

4. Simulation is becoming the norm in residency training programs.

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