Does Repeated Exposure to Critical Situations in a Screen-Based Simulation Improve the Self-Assessment of Non-Technical Skills in Postpartum Hemorrhage Management?

Abstract

Background. Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Non-technical skills (e.g. communication) are now recognized as a contributing factor to medical safety. In the field of simulation, screen-based simulations are currently very popular with computer/technological development. This study evaluates a screen-based simulation device, PerinatSims, developed to improve technical and non-technical skills in PPH situation. This experiment hypothesized that exposure and repetition of training with PerinatSims would improve the self-assessment of non-technical skills, and therefore increase the ability to manage PPH. Methods. The primary endpoint was a self-assessment of non-technical skills during simulation session of PPH on a digital simulator. Twenty French midwives performed three of nine 25 minutes sessions of PPH screen-based simulation. Four self-assessment questionnaires were administered at the end of each simulation session: a leadership/team working questionnaire (BAT), a negative feelings/emotional questionnaire (DASS-21), a Flow questionnaire and a mental load questionnaire (NASA-TLX). Results between sessions were compared using a repeated measures ANOVA followed by a Bonferroni post hoc test. Results. The study showed a positive evolution during the three screen-based simulation sessions: an increase of leadership and team working self-assessment, an increase of Flow sense, and a decrease of negative emotions (anxiety and depression in the DASS-21 score). Significant decrease of stress was found only between the second and the third sessions, and significant differences in the NASA-TLX were observed only in two dimensions, Performance and Frustration. Conclusion. A repeated exposure to PPH situations with a screen-based simulation tool improved the midwives’ self-assessment, especially for leadership, team working, emotion management and Flow sense. Furthermore, midwives had a very positive feedback on the device. They highlighted the desire to use PerinatSims more often to be trained to PPH management, for technical as well as non-technical skills.