Training reduces errors and OBPI...

[richinma2005]

http://stm.sciencemag.org/content/2/19/19cm8.abstract
Sci Transl Med 17 February 2010:
Vol. 2, Issue 19, p. 19cm8
DOI: 10.1126/scitranslmed.3000679

* Commentary

Medical Education Research As Translational Science

1. William C. McGaghie

+ Author Affiliations

1.
Northwestern University Feinberg School of Medicine and the Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Chicago, IL 60611, USA. E-mail: wcmc@northwestern.edu

Abstract

Research on medical education is translational science when rigorous studies on trainee clinical skill and knowledge acquisition address key health care problems and measure outcomes in controlled laboratory settings (T1 translational research); when these outcomes transfer to clinics, wards, and offices where better health care is delivered (T2); and when patient or public health improves as a result of educational practices (T3). This Commentary covers features of medical education interventions and environments that contribute to translational outcomes, reviews selected research studies that advance translational science in medical education at all three levels, and presents pathways to improve medical education translational science.
The authors also reported that the fraction of babies born with an obstetric brachial palsy injury,
in which the baby's arm is paralyzed, was significantly reduced after training (18). ... Page 3


Footnotes

*

Citation: W. C. McGaghie, Medical education research as translational science. Sci. Transl. Med. 2, 19cm8 (2010).

[richinma2005]

from the article :

A UK research group led by J. F. Croft s
trains and evaluates obstetricians and midwives
in the management of complicated deliveries
involving shoulder dystocia, during
which delivery of an infant’s shoulder is obstructed
by the mother’s pelvis. In an initial
CME multisite randomized trial involving
45 doctors and 95 midwives that compared
low- and high-fi delity mannequins for management
of shoulder dystocia, Croft s et al.
found that both training devices improved
pre- to post-test performance in the simulation
laboratory, as measured by the use of
basic maneuvers, successful deliveries, and
good patient communication (17), a T1 outcome.
Trainees who used the high-fi delity
mannequin also achieved a higher successful
simulation laboratory (T1) delivery rate
than those who used the low-fi delity device.
Th e authors concluded that SBE on handling
shoulder dystocia is eff ective, and medical
education research results can be used to
inform health policy (17).
A subsequent retrospective, observational
study at one of the UK hospitals that participated
in the previous study (17) compared
the management and neonatal outcome of
births complicated by shoulder dystocia before
and aft er the introduction of SBE (18).
Outcomes were evaluated using pre- and
post-SBE intrapartum and postpartum birth
records in which diffi culty with the infant’s
shoulders was recorded. Although shoulder
dystocia rates in the two periods were similar,
post-training clinical management showed
statistically signifi cant and clinically meaningful
improvement on six measured clinical
performance variables: (i) the use of McRoberts’
position, in which the mother’s legs are
pressed to her abdomen to widen the pelvis;
(ii) the application of pressure to the lower
abdomen (suprapubic pressure); (iii) the use
of an internal rotational maneuver; (iv) delivery
of the posterior arm; (v) no recognized
maneuvers performed; and (vi) documented
excessive traction on the infant’s head (T2
outcomes). Th e authors also reported that
the fraction of babies born with an obstetric
brachial palsy injury, in which the baby’s arm
is paralyzed, was signifi cantly reduced aft er
training (18). Th is followup observational
study demonstrates T3 medical education
research, because better patient outcomes
stemmed directly from the T2 results of the
prior educational intervention