Reducing trainee mistakes. Better performance with changing to a high-fidelity simulation system?

Postpartum hemorrhage is a significant cause for both maternal morbidity and mortality worldwide and is increasing in incidence. The aim of the study was to assess improvement and identify shortcomings in trainee performance in different simulation systems in the management of postpartum hemorrhage. To perform a pilot study evaluating and comparing high- and low-fidelity simulation models, assessing improvement in repeated performance with high-fidelity mode and identifying mistakes made assessed by objective structured assessment of training and skills (OSATS) and thereby exploring what aspects of emergency management of postpartum hemorrhage should be prioritized in teaching settings as well as assessing what simulation setup is most effective in achieving competence We performed a prospective randomized, single-blinded, single institution trial in a population of 17 junior obstetric trainees at the Charité University Hospital Obstetric Simulation Center in Berlin. Trainees were randomized into 2 groups, with either initial low-fidelity simulation or high-fidelity simulation, followed by repeated assessment of performance, using the high-fidelity model simulation system. Individual simulation sessions were video recorded, transcribed and timing of interventions documented. Standardized Objective Structured Assessment of Technique and Skills (OSATS) forms were used as a checklist for performance. There was a statistically significant general improvement in performance (p=0.02 (24.7 to 27.2 of 31 points; of average 8.7%)) in the second cycle of simulation assessment and a statistically significant training effect (p=0.043 (24.4 to 28.4 of 31; of average 12.9%)) in the group nderwent repeat simulation assessment from the initial low-fidelity to the high-fidelity system compared to the group using the same high-fidelity set up (p=0.276 (25 to 25.8 of 31, average of 2.4%)). There was an improvement in the performance when trainees underwent a repeated cycle of simulation assessment changing from a low fidelity to a high-fidelity system. Simulation assessment can identify mistakes and learning gaps that are important for obstetric trainees. We found that trainees make the same mistakes regardless of which simulation model was initially used.