Practical obstetric multi-professional training (PROMPT): the evidence for effective training

OBJECTIVE: To test the hypothesis that Practical Obstetric Multi-Professional Training (PROMPT) is effective training. BACKGROUND: Multi-professional training in the labour ward has, in most cases, shown to be effective, in some cases not to be effective, and in some instances, it has worsened the outcome following the introduction of training. If training is to be performed, it should be adequate training. Thus, monitoring the outcomes is mandatory to determine if training is effective. Adjustments become possible to achieve improved outcomes. PROMPT Training has 14 modules: Team working, Basic life support and maternal collapse, maternal cardiac arrest and advanced life support, maternal anaesthetic emergencies, foetal monitoring in labour, pre-eclampsia and eclampsia, maternal sepsis, major obstetric haemorrhage, shoulder dystocia, cord prolapse, vaginal breech birth, twin birth, acute uterine inversion, basic newborn resuscitation. The concept involves scientifically written modules based on clinical studies, multi-professional training, central integration of teamwork and communication training and multi-professional training in the labour ward for obstetricians, midwives, neonatologists, anaesthetists and further professions involved. DESIGN: Systematic literature review. METHODOLOGY: A systematic literature search of PubMed, Embase, Medline, Scopus, and the Cochrane Library was conducted for studies published between January 2000 and November 2024. Eligible studies evaluated PROMPT training and reported clinical outcomes, training effects, or cost-effectiveness. Forty-two studies met inclusion criteria, comprising randomised controlled trials, observational cohorts, and quasi-experimental designs. Methodological quality was assessed using the Cochrane Risk of Bias tool, and sensitivity analyses explored consistency across study types. RESULTS: A total of 62 studies were identified, of which 42 met the inclusion criteria and were analysed across 14 PROMPT training modules; 20 publications were excluded. Of the eligible studies, 37/42 reported improvements in 8/14 modules, most notably in teamwork and communication, management of shoulder dystocia with reductions in brachial plexus injury, decreased rates of hypoxic-ischaemic encephalopathy and low 5-min Apgar scores, improved management of pre-eclampsia with increased magnesium sulfate use, reduced decision-to-delivery intervals for umbilical cord prolapse, and better outcomes in postpartum haemorrhage, breech and instrumental deliveries, maternal cardiac arrest, and neonatal resuscitation. Additional findings included reduced litigation costs and evidence of cost-effectiveness. Three studies demonstrated no significant improvement, one trial reported worsened 5-min Apgar scores after implementation in 12 Scottish maternity units, and one study showed mixed outcomes. At Hannover Medical School, our own data demonstrated substantially reduced adverse outcomes after 2½ years of PROMPT training. CONCLUSIONS: PROMPT Training effectively reduces adverse outcomes of rare but severe obstetric complications, if training is implemented using authentic PROMPT materials, team and communication training will be implemented, and training will be repeated annually in a multi-professional way.