A Low-Cost Trainer for the Surgical Management of Postpartum Hemorrhage
Meleen Chuang1, Heena Purswani, Melissa J Fazzari
1From the Department of Obstetrics & Gynecology and Women's Health (M.C., J.K., E.H.B.), Montefiore Medical Center; Albert Einstein College of Medicine (M.C., H.P., J.K., E.H.B.); Department of Epidemiology and Population Health (M.J.F.), Albert Einstein College of Medicine, Bronx, NY; and Department of Obstetrics & Gynecology and Women's Health (S.P.), Stamford Hospital, CT.
Introduction:
Simulation-based training to manage surgical postpartum hemorrhage allows for improved preparation for these rarely needed life-saving procedures. Our objectives were to design a low-tech simulation model for use in training and evaluation of surgical techniques for the management of postpartum hemorrhage and to present evidence of its validity in assessment and training.
Methods:
Fifty-two obstetrics and gynecology residents and 25 attending physicians from an academic hospital were video recorded while performing the O'Leary and B-Lynch techniques on the low-tech model. Performance was evaluated using a Technical Skills Checklist, for B-Lynch and O'Leary techniques, and the Reznick's Global Rating Scale. Interrater reliability was computed to assess the consistency of the ratings between 2 raters. Average scores were determined and compared between incoming residents, junior residents, senior residents, and attending physicians to show construct validity.
Results:
For the B-Lynch, Technical Skills Checklist scores (maximum 17 points) of attendings (15.04) and senior residents (15.12) were higher than those of junior residents (5.63) and new residents (3.38). Global Rating Scale scores (maximum 25 points) on the B-Lynch reflected the same increase (22.38, 19.35 vs. 8.85, 6.75, respectively). For the O'Leary stitch, the scores of attendings, senior, junior, and incoming residents were as follows: 15.20, 13.65, 11.54, and 2.83, respectively (maximum 19 points). This supports the construct validity of the model. The model was considered realistic and useful for improving surgical skills in 71.4% of participants.
Conclusions:
This low-cost, easily constructed model is a useful tool for training these surgical skills.
