Simulation training in cesarean delivery

Surgical training has always been an essential element of obstetrics. Skills acquisition for cesarean delivery relies heavily on apprenticeship-style training, with a notable paucity of formal simulation training before taking an active role in surgery. Patient safety is compromised when surgeons possess poor surgical skills and inadequate knowledge to handle acute emergencies. Experience comes with "real-world" exposure or can be obtained in a simulated setting, where scenarios can be practiced without the risk of patient harm. As part of a larger Intensive Course in Obstetric Emergencies, a systematic and standardized 1-day simulation-based training for cesarean delivery was formulated and conducted. Our multimodal curriculum includes online precourse lectures and video resources combined with on-site skills training with simulated scenarios and workshops for core and complex skills. The curriculum emphasizes presurgical planning, the execution of quick appropriate maneuvers, anticipation of complications, and effective management of complications. Simulation training includes surgical emergencies, such as skin and uterine incisions, difficult fetal extraction, and management of hysterotomy extensions. Postpartum hemorrhage management is practiced, including compression sutures, pelvic devascularization, resuscitative hysterotomy, placental complications, and cesarean hysterectomy. Simulation is performed using equipment of varying fidelity, along with our training manual. A standardized curriculum that leverages adult learning theory, combined with rapid feedback to learners serves as the backbone of the course, ensuring consistency and quality. Although high-fidelity equipment enhances curriculum delivery, it is not an absolute necessity. Equipment mobility must be considered when conducting training in multiple regions. The training experience and outcome across 3 different countries, Malaysia, Thailand and Japan, were described and compared. Analysis of pre- and postskills test scores demonstrated improvement in all 6 cesarean skills tested across all groups. Our curriculum proved effective in terms of practicality, adaptability, and cost. The training is reproducible and modifiable for learners in different countries. Moreover, surgeons in attendance of the course valued the training experience.