Assessing Shoulder Dystocia Simulations for Quality

1. Assessing Shoulder Dystocia Simulations for Quality Elizabeth Yznaga, CNM, MSN, sDNP University of San Francisco, Kaiser Permanente San Jose

2. Quality Shoulder Dystocia Simulations • Quality simulations balance internal and external validity. • They are designed to demonstrate replicability, integrity and generalizability. • Quality can be observed and tracked by process checklists and assessment forms. • Participants recognize quality as learner support, excellent feedback, and a coherent reflection of real life events. Prion, 2008

3. Inherent structural validity Unique restrictions of time, language, personnel, and actions promote internal and external validity Internal Validity External Validity Generalizability

4. Quality characteristics Clear objectives: Learning, practice or drill Reliability of the content: Evidenced-based, and standardized Reliability of the experience: Scripted scenario, consistency in treatments ( fetal manikin), clear directions, and endpoints Jefferies (2007) Consistent trainers: Standardized cues and other participant support Documentation: Checklists for process and assessment, audiovisual records decrease bias in assessment Thoughtful Feedback: Respectful, standardized forms with empirical, aesthetic, personal, ethical, and reflection prompts Johns (2004), Jefferies (2007) Evaluation: Promotes improvement and integrity

5. Tracking quality • Increase fidelity with checklists: the setting, participant roles, manikin, and equipment • Standardized forms for observation and audiovisual assessments • Pre and post testing of content and confidence • Electronic simulators are high fidelity by their limited nature • The plastic pelvis and doll are low fidelity unless consistent treatments are followed • Quality is not conferred by the manikin, but by the scenario

6. Design for the site Scheduled simulations Birth center and home birth • Best control of most factors • Education costs • Easier to use audio video technology • Flexible participants • Informal team building • Short programs • Shift acuities may degrade the simulation • Simple checklists • Small teams • Multiple responsibilities On shift simulations Hospital sites • Multidisciplinary teams • Complexity = participants • Multiple checklists and evaluators

7. Performance check points • Identify the problem • Call for help: assistants, nurses, pediatricians, neonatal code team • Communicate with the staff and the patient and family • Call out and perform the maneuvers • Document the delivery • Feedback Define the basic tasks

8. Assessments: measuring quality Track the study or course methods of assessment Track the shoulder dystocia maneuvers Track the internal validity of the scenario

9. Summative Evaluation

10. Summary • Design the simulation to reflect the site, the objectives • Maintain internal validity by the use of scripts, checklists and consistent trainers • Develop external validity by sharing scripts, checklists and assessments with other entities • Design basic simulations for on-site, spontaneous practice