Simulation is the imitation or representation of one act or system by another. According to the Society for Simulation in Healthcare (2015), simulation in medicine has four purposes to aid patient safety: (1) education, (2) assessment, (3) research, and (4) health system integration. During the past few years, simulation has been advanced as a technique to improve obstetric training and thus patient safety. Currently, many obstetric surgical techniques are decreasing in frequency, and this stems in large part from inadequate training due to declining procedure numbers. Thus, simulation poses a solution to this negative cycle by providing hands-on practice.
OBSTETRIC SIMULATION EVOLUTION
For decades, military and commercial aviation has used simulation not only to train pilots but to test them as well. In simulators, pilots are required to demonstrate their proficiency in basic skills and to practice for rare but critical events. Beginning in the 1990s, simulation in obstetric training was implemented, and evaluation has rapidly developed (Gardner, 2008). Thus, in addition to current training that includes didactic lectures and bedside teaching, simulation provides another learning format.
Initially, educational intentions drove simulation development in obstetrics. Since then, academics has been challenged by limitations that include work-hour restrictions, professional liability concerns, insurance payer pressures for shorter hospital stays, and teaching in front of an alert patient. These spurred medical schools to invest in simulation centers to provide a foundation for clinical teaching across specialties.
In obstetric residency training, profound challenges have arisen, and procedural experience has declined during the past two decades. The Accreditation Council for Graduate Medical Education Residency Review Committee (2015) has markedly restricted the tabulation of resident experience to all but four obstetric categories: (1) spontaneous vaginal delivery, (2) cesarean delivery, (3) operative vaginal delivery, (4) and sonographic examination. It is unclear whether this was done because broad national experience in the management of many conditions has become scarce or because the committee did not believe that procedures such as fourth-degree laceration repair, breech delivery, and twin delivery were important skills to master in residency. Importantly, of the four categories that are still reported to the Residency Review Committee, case log numbers have declined for nearly all categories in the past several years. For example, currently more than half of all graduating residents have performed fewer than 25 operative vaginal deliveries. Thus, simulation curriculums have been developed to supplement teaching of technical skills.
OBSTETRIC SIMULATION GOALS
Defining qualities of effective simulation-based education have been described in descending order of their importance: (1) providing feedback, (2) repetitive practice, (3) curriculum integration, (4) range of difficulty, (5) multiple learning strategies, (6) capture of clinical variation, (7) controlled environment, (8) individual learning, (9) defined outcomes, and (10) simulator validity (Issenberg, 2005). As the field fully integrates obstetric simulation into its training armamentarium, the ultimate goal is to make labor and delivery safer and ...