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DR G MUNISWARAN
ICOE TRAINER
Impact of
skills
training
Declaration
Principle trainer for ICOE
Overview
Intensive Course in Obstetric Emergencies (ICOE)
Simulation based training
Lessons from training in Obstetric Emergencies
The future
Obstetric Emergencies
Simulation based training
ICOE
Intensive Course in Obstetric Emergencies (ICOE)
2 day course initiated by the Obstetrics & Gynaecological Society of Malaysia in 2014
Emphasizing “core” and “advanced” skills
DR G MUNISWARAN
ICOE TRAINER
Impact of skills training Experiences from Malaysia, Myanmar, Mongolia,
Bangladesh, Cambodia & India
Lessons
Team management
was lacking
Communication was inefective
Resuscitative hysterotomy
CPR & Senior Obstetricians
Low fidelity models are effective for
PPH skills Feedback
Impact of simulation on
knowledge & skills
Technology in
obstetric
emergencies
Ineffective Communication
Visual estimation of blood loss
Increase in incidence of PPH
Increase in medications for PPH
Reduction in hysterectomy &
surgical interventions
Simulation training on knowledge & skills
Improvement in knowledge is not significant between pre & post
test
Significant improvement in skills
Good knowledge does not mean skillful
Impact of ICOE on CPR skills
Malaysia Myanmar Mongolia Bangladesh Cambodia
4.6
5.66
3.5
5.8
8.88
98.5
10
CPRPre-test Post-test
6.6
5.85.3
6.9
9.2 9.48.8
9.3
ECLAMPSIA SHOULDER DYSTOCIA VAGINAL BREECH DELIVERY UTERINE INVERSION
Core skills
Pre-test Post-test
Impact of ICOE on core skills
Cadre of participants & training
0
2
4
6
8
10
Consultant Specialist MO/Registrar
3.5
5.8 5.8
8.27.6 7.6
Pre-test Post-test
31% 31%134%
Low fidelity models for compressions sutures and
Balloon tamponades
PPH management
Malaysia & other countries
Malaysia
Better in PPH identification
Skilled in medical and non
surgical management of
PPH
Myanmar, Mongolia,
Bangladesh & Cambodia
Better skilled in hysterectomy
Less skilled in proper technique
of B Lynch
How to conduct a drill
Simulation models
Setting
Co coordinator
Objectives
Assessment a) Knowledge
b) Skills
c) System
d) Team work
Benefits of feedback
Reinforces objectives
Better impact in learning
Extremely beneficial
Technology & Obstetric Training
Pretest & post test – mobile phones/ tablets – uptake 100%
Pre-test score discussed real time – google doc
Participants engaged better
Results obtained real time
FEEDBACK
96
94 94
92
BENEFICIAL GOOD USE OF TIME ENJOYABLE PARTICIPATION ON
HANDS ON
Percentage
Challenges faced
Hierarchical system
Resistance to new
evidence
No set objectives
Lack of reflective practice
Difference resources & languages
How did we adapt
Interpreters / local
language
Allowing junior staffs to speak
Engage local
trainers
Settinggoals
Feedback
Future
Retention of knowledge
Cost effectivemodel
Impact on morbidity &
mortality
Interactive
E manual
Hospital based multi-
professional training
Take home message
Simulation based training is the way forward
for skills
Low fidelity models are
effective for PPH skills
Teammanagement
should be emphasized
CPR is often forgotten
A good course should be able
to adapt to local needs
Retraining and revalidation
THANK
YOU
