PTBi EA simulation and team training – knowledge and skills assessment

Introduction: Simulation training in basic and emergency obstetric and
neonatal care has previously shown success in reducing maternal and
neonatal mortality in low-resource settings. Though preterm birth is the
leading cause of neonatal deaths, application of this training methodology
geared specifically towards reducing preterm birth mortality and morbidity
has not yet been implemented and evaluated.  Methods: The East
Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster
randomized controlled (CRCT) trial that successfully improved outcomes of
preterm neonates in Migori County, Kenya, and the Busoga region of Uganda
through an intrapartum package of interventions. PRONTO simulation and
team training (STT) was one component of this package and was introduced
to maternity unit providers in 13 facilities. This analysis was nested
within the larger CRCT and specifically looked at the impact of the STT
portion of the intervention package. The PRONTO STT curriculum was
modified to emphasize prematurity-related intrapartum and immediate
postnatal care practices, such as assessment of gestational age,
identification of preterm labour, and administration of antenatal
corticosteroids. Knowledge and communication techniques were assessed at
the beginning and end of the intervention through a multiple-choice
knowledge test. Clinical skills and communication techniques used in
context were assessed through the use of evidence-based practices (EBPs)
as documented in video-recorded simulations through StudioCodeTM video
analysis. Pre-and-post scores were compared in both categories using
Chi-squared tests.  Results: Knowledge assessment scores improved
from 51% to 73% with maternal-related questions improving from 61% to 74%,
neonatal questions from 55% to 73%, and communication technique questions
from 31% to 71%. The portion of indicated preterm birth EBPs performed in
simulation increased from 55% to 80% with maternal-related EBPs improving
from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication
techniques from 52% to 69%.  Discussion: STT substantially
increased preterm birth-specific knowledge and EBPs performed in
simulation.

引言：既往研究证实，在资源匮乏地区开展的基础与急诊产科及新生儿护理模拟培训，可有效降低孕产妇及新生儿死亡率。尽管早产（preterm birth）是新生儿死亡的首要诱因，但专门针对降低早产相关死亡率与发病率的该类培训方法，目前尚未得到应用与评估。
方法：东非早产倡议（East Africa Preterm Birth Initiative, PTBi-EA）是一项多国家整群随机对照试验（cluster randomized controlled trial, CRCT），通过一套产时干预套餐，成功改善了肯尼亚米戈里县与乌干达布索加地区早产新生儿的预后。PRONTO模拟与团队培训（PRONTO simulation and team training, STT）是该干预套餐的组成模块之一，已面向13家医疗机构的产科护理人员开展。本分析嵌套于该项大型整群随机对照试验之中，专门考察干预套餐中STT模块的应用效果。研究对PRONTO STT课程进行了优化调整，重点突出与早产相关的产时及即刻产后护理操作，包括胎龄评估、早产临产识别以及产前糖皮质激素给药。研究分别于干预开始与结束时，采用选择题知识测试评估参与者的知识储备与沟通技巧。针对临床实操技能与场景化沟通技巧，则通过循证实践（evidence-based practices, EBPs）标准进行评估：借助StudioCode™视频分析工具，对录像记录的模拟场景中操作者的表现进行评分。研究采用卡方检验，对两类评估的干预前后得分进行组间比较。
结果：知识评估得分从51%提升至73%，其中孕产妇相关题目得分从61%升至74%，新生儿相关题目得分从55%升至73%，沟通技巧类题目得分从31%升至71%。模拟场景中符合临床指征的早产相关循证实践执行占比从55%提升至80%，其中孕产妇相关循证实践从48%升至73%，新生儿相关循证实践从63%升至93%，沟通技巧得分从52%升至69%。
讨论：STT可显著提升针对早产的专项知识储备，以及模拟场景中的循证实践执行能力。