Obstetric training enhances EM residents’ confidence in emergencies

Obstetric training enhances EM residents’ confidence in emergencies | Image Credit: © Africa Studio - © Africa Studio - stock.adobe.com.

The comfort of Emergency Medicine (EM) residents when managing complicated obstetric conditions may be improved through obstetrician-led lecture and simulation-based training, according to a recent study published in Cureus.¹

Training for high-risk, low frequency medical events is often performed through a lecture- and simulation-based approach. Data from 2019 has indicated increased knowledge and skills in EM and OBGYN physicians through this method.²

Emergency department encounters with pregnant patients

Approximately 1 in 3 pregnant patients presented to the emergency department (ED) during pregnancy in 2022, highlighting frequent encounters for EM residents with pregnant individuals.¹ This increases the odds for EM physicians to experience complex obstetric conditions and situations.

“While a lecture-based approach is the traditional teaching model and simulation-based training is a more modern form of medical training, both are ideal approaches for solidifying the basic recognition, assessment, and management of complex obstetric situations,” wrote investigators.

Study design and participant criteria

The pre-post intervention study was conducted from October 2023 to January 2024 to evaluate the efficacy of obstetrician-led lecture- and simulation-based training for improving EM residents’ comfort in managing complicated obstetric conditions. Participants included resident physicians of the Mercy St. Vincent Medical Center residency program.

Active employment as an EM within the residency program was required for inclusion, with exclusion criteria including prior formal obstetric training outside the current resident education. Clinical scenarios in the training course included shoulder dystocia, breech vaginal delivery, severe hypertensive disorders of pregnancy, and resuscitative hysterotomy.

The training began with a 2-hour lecture discussing the clinical scenarios. An OBGYN resident and attending physician wrote the lectures based on current, evidence-based clinical recommendations. Focus was placed on recognizing, assessing, and managing the clinical scenarios.

Simulation training was completed 1 week after the lecture and allowed residents to encounter term pregnant patients at the ED for complaints related to a clinical scenario. Hands-on participation was available in delivery maneuvers for shoulder dystocia, breech vaginal delivery, and resuscitative hysterotomy.

A standardized patient actor was included in severe hypertensive disorder of pregnancy simulations. Participant comfort was assessed through pre- and post-training surveys employing a 5-point Likert scale. Responses detailed frequency count and percentage separately.

Survey results and resident comfort levels

Pre-education surveys were completed by 32 EM residents and post-education surveys by 25, none of whom were excluded from the analysis. Having no prior experience with shoulder dystocias, breech vaginal deliveries, and resuscitative hysterotomies was reported in 75%, 78%, and 88% of residents, respectively.

Comfort levels were low before education, at 9% for shoulder dystocia, 3% for breech vaginal delivery, and 3% for resuscitative hysterotomy. However, the rate of comfort for severe hypertensive disorder was 31%. Reasons for a lack of comfort included a lack of training and lack of prevalence.

Eighty-eight percent of residents strongly agreed training would improve their comfort, and increased comfort was found in all clinical scenarios following education. This included comfort recognizing shoulder dystocia, breech vaginal delivery, severe hypertensive disorders of pregnancy, and indicated resuscitative hysterotomy at 96%, 96%, 96%, and 92%, respectively.

Comfort performing maneuvers for shoulder dystocia was reported by 84% of respondents. For breech delivery, 76% were comfortable performing maneuvers and 28% were comfortable performing the delivery without an OBGYN.

All respondents were comfortable performing the initial work-up and stabilizing severe hypertensive disorders of pregnancy. A rate of 100% was also reported for understanding the materials for performing resuscitative hysterotomy, with 60% of respondents comfortable performing the procedure.

Conclusion

“Obstetrician-led lecture- and simulation-based training can improve EM residents’ comfort in managing complicated obstetric conditions,” wrote investigators. “Future investigations should be considered to determine the relationship between such training and competency in complicated obstetrics.”

References

1. Myers G, Huckaby A, Buderer N. Improving comfort in obstetric skills of emergency medicine residents with lecture- and simulation-based training. Cureus. 2025;17(1):e77836. doi: 10.7759/cureus.77836
2. Matenchuk BA, Rosychuk RJ, Rowe BH, et al.: Emergency department visits during pregnancy. Ann Emerg Med. 2023;81:197-208. doi:10.1016/j.annemergmed.2022.06.021