The effectiveness of training in emergency obstetric care: a systematic literature review

Abstract

Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before–after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.

Using the Kirkpatrick Model to evaluate the Maternity and Neonatal Emergencies (MANE) programme: Background and study protocol

“…Several reviews have highlighted the active components of effective emergency obstetric training including: institution-level incentives to training; regular, multiprofessional, mandatory, ‘in house’ training; teamwork training integrated with clinical teaching; and the use of on-site high-fidelity simulation models,20 21 but in some studies, training for obstetric emergencies is not always found to be effective in terms of measurable change in clinical outcomes 22 23. However, a recent systematic review investigating the effectiveness of training in emergency obstetric care found strong evidence for improved clinical practice in areas such as adherence to protocols, resuscitation technique, communication and teamwork, as well as improved neonatal outcomes such as reduced trauma after shoulder dystocia 24. It did not, however, find strong evidence for a reduction in other outcomes such as postpartum haemorrhage, maternal death and stillbirth rates 24.…”

“…However, a recent systematic review investigating the effectiveness of training in emergency obstetric care found strong evidence for improved clinical practice in areas such as adherence to protocols, resuscitation technique, communication and teamwork, as well as improved neonatal outcomes such as reduced trauma after shoulder dystocia 24. It did not, however, find strong evidence for a reduction in other outcomes such as postpartum haemorrhage, maternal death and stillbirth rates 24. Further, a large randomised controlled trial of PROMPT (PRactical Obstetric Multi-Professional Training) which included over 87 000 births in Scotland, published after the systematic review, found no improvement in neonatal outcomes (measured by the number of infants with an Apgar score of less than 7 at 5 minutes) 25…”

Provider-Perceived Benefits and Constraints of Complete Adherence to Antenatal Care Guideline Among Public Health Facilities, Ethiopia: A Qualitative Study

“…Research shows that short and competency-based 'in-service' training in emergency obstetric care results in signi cant improvements in healthcare provider competence and a move to making better use of guidelines (37).In addition, training at the start of implementation and continuing education throughout the implementation process is to be recommended to increase the use of guidelines (38). Lack of up-todate training opportunities was identi ed as a constraint that hinders the full implementation of guideline use in our present study which is concurrent with a previous study done in Mozambique (11).Participants reported differences in in knowledge of existing ANC guidelines..…”

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics*

“…The use of simulators and simulation environments for teaching health professionals is well established in the literature (5,(7)(8) . Although the quality of studies is heterogeneous and with several different indicators, evidence has shown that simulation-based teaching is effective and leads to better and more lasting results than traditional teaching (7,9) .…”