Use of Obstetric Emergency Interprofessional Simulation in a Rural Setting to Improve Knowledge, Self-efficacy, and Attitudes

Background: Utah has ten counties with fewer than six primary care providers, including OB- GYN providers, and two counties with none. Evidence-based obstetric (OB) practice in rural settings can be challenging outside of an academic medical care setting without strategies to ensure the dissemination of the evidence to rural providers who care for pregnant women. Using hands-on practice has been shown to increase didactic knowledge and confidence in healthcare workers implementing them. Providing simulations to rural clinicians using a translational approach is a supported method to improve knowledge, self-efficacy, attitudes towards teamwork, and skills regarding providing care during common OB emergencies. Methods: A quality improvement project implemented with PRONTOSTAT created a simulation on OB emergencies in Moab, Utah, with the Grand County EMS and Moab Regional Hospital. Three simulations were done in one training day involving neonatal resuscitation, postpartum hemorrhage, and an eclamptic seizure. The participants worked in situ with real actors, practicing skills they do not see very often in a rural community. Each simulation ended with an interprofessional debriefing. Prior to the training, participants took a pre-test on self-efficacy of knowledge and confidence. After, they completed a post-test and an evaluation of the training. Action plans were created for the participants to improve care gaps discovered during the simulation. Results: The participants' (n=15) self-efficacy of knowledge increased in diagnosing postpartum hemorrhage and hypertension in pregnancy, treatments to control bleeding and hypertension in pregnancy, care of a newborn who is not breathing, and providing neonatal ventilation based on a paired t-test (n=15) with a p-value < .01. The participants' self-efficacy in their confidence of managing bleeding after birth and hypertension in pregnancy increased (p< .01). The self- efficacy of confidence in neonatal resuscitation also increase (p-value < .05). All participants who completed the training evaluation agreed that they understood the objectives and purpose of the training planned to use the skills practiced, and interactive portions added to their understanding. Ninety-six percent of participants strongly agreed and agreed that this training would benefit others in their profession. Participants endorsed debriefings as constructive, they felt like this workshop was a good use of their time, and they appreciated the facilitators who supported them during the learning process. Conclusions: Interprofessional training is desired, accepted, and beneficial in rural communities. This quality improvement project showed that OB emergency simulations in rural Utah are necessary and valuable for preparing rural medical professionals to manage emergency OB situations. PRONTOSTAT simulation packs and exercises provided a feasible and convenient method for the Moab participants.