Obstetric simulation: State of the art in 2005

September 15, 2005

Practicing difficult deliveries on a manikin is not only for residents. Obstetricians in some areas may be able to reduce their malpractice premiums by taking simulation courses.

Obstetrics is one of many medical specialties in which efforts are under way to reduce medical errors and adverse events by improving patient safety. The malpractice crisis in ob/gyn, in part, has been fueled by the ramifications of preventable and nonpreventable adverse events.1 Labor and delivery nurses and physicians often get blamed for poor birth outcomes, yet we tend to be unwilling to openly discuss errors and effectively deal with them because of a culture of blame and shame.

One way to improve patient safety is to expand the use of medical simulation, which offers health-care professionals a unique way to learn skills without harming real patients. In medical simulation, assessment, clinical decision-making, and procedures are practiced on patient manikins. Simulation originated in very hazardous, nonmedical industries and then was adapted for use in health care by anesthesiologists during the late 1980s-early 1990s.2 Simulators in obstetrics are in their infancy, but offer labor and delivery physicians and nurses a tremendous opportunity to learn and practice their skills.3-5 We'll review the current status of obstetric simulation and provides a perspective on what technologic developments are necessary for its widespread adoption by obstetric units and educational institutions throughout the United States.

What is an obstetric simulator?

There are about 200 medical simulation centers worldwide, most equipped with low-fidelity simulators. Each center has its own way of operating, but most emphasize procedural skills training. Larger centers may offer training in both procedural and behavioral skills, and conduct research in technology development, assessment of competency, and evaluation of performance.