The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training

Abstract

Objec ve:To compare learning outcomes of postpartum hemorrhage simula on training based on either instruc onal design guidelines or best prac ce. Methods:A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013.The instruc onal design group included 13 teams, whereas the best prac ce group included seven teams. A standardized task checklist was used for scenario analysis and the propor on of correctly executed tasks compared (post-test minus pretest). Results:The instruc onal design group scored higher than the best prac ce group for total number of tasks completed (median difference 0.46 vs 0.17; P< 0.001; effect size[ r ]=0.72). Similar results were observed for communica on (median difference 0.56 vs 0.22; P= 0.004; r= 0.58), laboratory evalua on (median difference 0.83 vs 0.00; P< 0.001; r= 0.76), and mechanical management (median difference 0.25 vs -0.15; P= 0.048; r= 0.39). Speed of learning was also increased. The median differences were 0.20 for the instruc onal design group compared with 0.05 for the best prac ce group at 60 seconds ( P= 0.015; r= 0.49), and 0.49 versus 0.26 ( P= 0.001; r= 0.65) at 360 seconds. Conclusion:The use of simula on training for postpartum hemorrhage that was based on instruc onal design guidelines yielded be er learning outcomes than did training based on best prac ce. K E Y W O R D S Educa on ; Instruc onal design ; Postpartum hemorrhage ; Simula on training ; Situa onal awareness ; Training 1 | INTRODUCTION Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, par cularly among deaths that are considered avoidable. 1 Frequently reported assistance failures associated with preventable PPH include delay in diagnosis, poor communica on, insufficient teamwork, and lack of adequate educa on and training. 2,3 Simula on training has emerged as a widespread strategy to overcome such failures. Systema c reviews of simula on-based healthcare educa on debate the best way to deliver instruc onal features to ensure op mal effec veness of training. 4,5 Nonetheless, a growing body of evidence recommends that training formats should be based on reliable educa onal principles, par cularly instruc onal design guidelines. 6 The Four-Component Instruc onal Design model 7 and Merrill ' s First Principles of Instruc on 8 summarize the main guidelines. According to the guidelines, effec ve instruc on should contain authen c, relevant, and daily real-world problems, emphasize prac ce at 100 | DE MELO ET AL. different levels of complexity, and provide feedback and diminishing instruc onal support through training. 7When devising a PPH simula on training format based on instruconal design guidelines, the learning objec ves should be clearly idenfied and summarized in strategies that aim to overcome recurrent assistance failures. Such learning objec ves include situa onal awareness enhancement, 9 improvement of both communica on and teamwork skills and a tudes, 10 and reinforcem...

Self‐perceived long‐term transfer of learning after postpartum hemorrhage simulation training

“…The participants received two visual aids to facilitate recollection: the picture summarizing the PPH protocol (Fig. ) and a picture summarizing the PPH simulation steps from each training format . The interviews were audio‐recorded and typically lasted 20 minutes.…”

“…In the present qualitative study, semistructured interviews were conducted between August 7 and September 26, 2015, with healthcare practitioners who had attended one of two different PPH simulations (based on ID or BP) 2 years previously. 15 At the time of the simulations, all attendees were residents at one of the five teaching hospitals in Recife, Brazil, in one of the 3 years of the obstetrics and gynecology program. Using a simple randomization method (masking of names), six attendees from each simulation format were selected for invitation to interview from a total of 54 attendees.…”

“…1) and a picture summarizing the PPH simulation steps from each training format. 15 The interviews were audio-recorded and typically lasted 20 minutes. They were transcribed verbatim and T A B L E 1 List of instructional design elements used in the instructional design simulation group.…”

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

“…Particularly in Obstetrics teaching, the use of simulators and simulation environments has been studied in various settings (8) , mostly obstetric emergencies such as shoulder dystocia (11)(12) , postpartum hemorrhage (13)(14)(15)(16)(17)(18) , pre-eclampsia and eclampsia (16)(17) . There is also evidence on simulation to enhance surgical skills such as suturing of vaginal and severe lacerations (19) .…”

“…A piece of curvy fabric (synthetic leather), for example, does not have the appearance of human skin, but with the proper assembly may be valid for suturing training. The structure of the simulation is considered to be a process, not a product, and the simulation training needs strategic planning in order to be effective (14) .…”