Background
Emergency response skills are essential when events such as seizure, anaphylaxis,
or hemorrhage occur in the outpatient setting. As services and procedures increasingly
move outside the hospital, training to manage complications may improve outcomes.
Objective
The objective of this study was to evaluate a simulation-based curriculum in outpatient
emergency management skills with the outcome measures of graded objective performance
and learner self-efficacy.
Study Design
This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and
Gynecology and Family Medicine in a simulation-based, outpatient emergency management
curriculum. Learners completed self-efficacy questionnaires and were videotaped managing
3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and
hemorrhage) in the simulation laboratory both before and after completion of the curriculum.
Evaluators who were blinded to training level scored the simulation performance videotapes
using a graded rubric with critical action checklists. Scenario scores were assigned
in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum.
Results
Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects’
objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants
demonstrated global improvement. When scores were stratified by previous outpatient
simulation experience, subjects with previous experience improved in all but management
of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated
improvement in all 7 measured areas: confidence, use of appropriate resources, communication
skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage
management. Self-efficacy assessment showed improvement in confidence managing outpatient
emergencies (P=.001) and ability to communicate well in emergency situations (P<.001).
Conclusion
A simulation-based curriculum improved both self-efficacy and objectively rated performance
scores in management of outpatient medical emergencies. Simulation-based curricula
should be incorporated into residency education.
Key words
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Article info
Publication history
Published online: September 15, 2017
Accepted:
September 7,
2017
Received in revised form:
September 3,
2017
Received:
July 3,
2017
Footnotes
Supported by a grant from the Association of Professors of Gynecology and Obstetrics (APGO) Medical Education Endowment Fund and a grant from the University of New Mexico Scholarship in Education Allocations Committee (SEAC).
The authors report no conflict of interest.
Cite this article as: Espey E, Baty G, Rask J, et al. Emergency in the clinic: a simulation curriculum to improve outpatient safety. Am J Obstet Gynecol 2017;217:699.e1-13.
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© 2017 Elsevier Inc. All rights reserved.
