Mixed methods evaluation of simulation-based training for postpartum hemorrhage management in Guatemala

Area of Science:

• Medical Education
• Obstetrics & Gynecology
• Global Health

Background:

• Postpartum hemorrhage (PPH) remains a significant cause of maternal mortality worldwide.
• Effective management strategies include the B-Lynch suture and uterine balloon tamponade (UBT).
• Simulation-based training (SBT) may enhance provider skills and confidence in PPH management.

Purpose of the Study:

• To evaluate the impact of SBT on provider attitudes, practices, and patient management for PPH in Guatemala.
• To compare the effectiveness of SBT for B-Lynch suture versus UBT.
• To identify barriers to UBT implementation.

Main Methods:

• A mixed-methods approach was used, combining surveys and qualitative interviews.
• An in-country SBT course on PPH management was conducted in Guatemala City.
• Participants included 39 OB/GYN providers with varying prior SBT experience.

Main Results:

• SBT significantly increased provider comfort in performing and teaching the B-Lynch suture (p<0.01).
• Qualitative data revealed greater provider comfort with B-Lynch compared to UBT.
• Key barriers to UBT implementation included resource limitations and hierarchical decision-making.

Conclusions:

• SBT demonstrates a stronger positive impact on provider comfort with the B-Lynch suture than with UBT.
• Understanding implementation challenges is crucial for optimizing UBT use.
• Mixed-methods evaluation provides a comprehensive assessment of training programs.