How to Do More with Less in Simulation

In 2015, more than 300,000 women died during pregnancy and immediately following childbirth.¹ 99% of these deaths occurred in developing countries.² Laerdal Global Health (LGH), a not-for-profit organization funded by Laerdal Medical, develops programs to reduce maternal and infant mortality rates in low-resource countries. We believe a lot can be learned from LGH’s experience that can be transferred to high-resourse environments.

LGH was founded in 2010. Working in partnership with Jhiepego, the American Academy of Pediatrics, and the Church of Latter-Day Saints, LGH has helped make tremendous improvements in the health of new mothers and newborns in developing countries. A study in Tanzania, for example, measured the success of the Helping Babies Breathe Program with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years.³ These same solutions that have made a difference in Tanzania can do the same in the United States and elsewhere.

Though medical facilities and professional training are more advanced in the U.S., there is always room for improvement. Each year in the U.S., approximately 700 women die each year as a result of pregnancy or delivery complications.⁴ The World Health Organization (WHO) calculates that about half of these are preventable.⁵ Fortunately, training using simulation is a proven way to identify and reduce preventable error.

In this article, we share how you can transfer Laerdal Global Health’s and its partners experience into your training setting to improve maternal and newborn care.

In low-resource areas, educators have no choice but to do more with less. The experience of teaching with less in this case, though, has inspired educators to return to the basics of curricular design and the fundamentals of simulation.

Most educators would argue that learning goals are the most important element in any class. As a reminder, without purposeful learning goals, there is no desired outcome to unify you as the educator with your learners.

Many experts recommend that you start with what your desired outcome is. Then, use the SMART framework to craft your learning goals accordingly. Ask yourself if your learning goals are…

LGH’s goal is to help save 400,000 more lives annually by 2020 by providing the tools and training to support health workers.⁶ By clearly defining what the organisation aims to achieve, LGH can create solutions and programs to help get you there. You, too, can set yourself up for success by using the SMART method to create strong learning goals and, subsequently, strong learning objectives.

As you begin to plan individual simulations, keep in mind the experience level of your learners as well as the setting where your learning will take place. You might not have the funding for a dedicated simulation lab – and that’s okay! Consider the setting of LGH’s trainings in Tanzania and use that as inspiration to get creative with the existing resources, faculty, and equipment you have.

One study compared two simulations – one using a standardised patient at a local hospital and one using a high-fidelity simulator in a simulation lab. In both settings, there were equal improvements among the learners.⁷ This proves that simulation, rather than the type of simulator, is the key to developing your learners.

Worldwide each year, 140 million women give birth.⁸ To improve the survival of new mothers and infants, healthcare professionals need to be given engaging and fulfilling training. Simulations that adhere to the best practices in adult learning can provide this. Not every situation requires high-fidelity to gain a high return on learning. Experts recommend matching the level of your simulation with the experience you need to create for effective learning to occur.

High-fidelity simulation training can lead to tremendous improvements in learner’s skills acquisition. For this reason, many educators adopt a form of tunnel-vision toward only high-fidelity simulation and may lose sight of their desired outcome in the process. Those new to simulation may find funding such high-fidelity simulators challenging and those experienced in simulation may be blind to other, complimentary methods of teaching.

LGH’s experience is proof that low-fidelity task trainers and simulators can vastly improve a learner’s technical skills and interpersonal skills. Without electrical requirements or complicated set-up. Through the Helping Mothers Survive program, developed in collaboration with Jhpiego,we have seen a 17% reduction in postpartum hemorrhage, 47% reduction in retained placenta, 34% reduction in intrapartum stillbirth.⁹ For this reason, you should not ignore low-fidelity simulation as an option.

In the United States, the cost of maternity care exceeds 60 billion dollars, yet women are still dying during pregnancy or childbirth.¹⁰ And, an estimated 60,000 women suffer complications that are near-fatal.¹¹ In response, some hospitals are beginning to implement more hands-on training to manage obstetric emergencies – and they are using simulation to accomplish this.

Low-fidelity simulation is also a great supplement to your program if you do have a fully-articulating birthing simulator. Learners that are new to the care procedures for a mother in labor may be overwhelmed by the technology of a full-body simulator. In this case, using a low-fidelity birthing simulator or task trainer can ensure that your learners are confident in their skills before introducing them to a more immersive training experience.

LGH’s experience training midwives and other healthcare professionals in rural areas shows the impact low-fidelity solutions can have. Whether your simulation experience level is high or low – or your facility is large or small – low-fidelity simulation is something to consider.