Improving resident confidence and knowledge in postpartum hemorrhage management with low-fidelity simulation training at a large teaching hospital in Ghana

Objectives Postpartum hemorrhage (PPH) is the leading cause of maternal death in low- and middle-income countries, and training in PPH management is a research priority of the World Health Organization. Most studies showing benefit of obstetric simulation as a teaching modality used high-fidelity simulators in high-resource settings. Our goal was to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in managing PPH. Methods We conducted a pre/post study of a PPH simulation exercise at a tertiary hospital, using a low-fidelity birthing simulator and questionnaires. Resident confidence and knowledge in PPH management were measured before and after using 5-point Likert scales (from 1-5) and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, percentages, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Results Mean confidence scores across all items increased from 3.5 before the intervention to 4.6 after the intervention for a mean increase of 1.0 (95% confidence interval (CI), 0.9–1.2). Mean knowledge scores increased from 8.1 to 9.4 for a mean increase of 1.3 (95% CI, 0.9–1.6). All 35 participants agreed the simulation was educational, relevant and realistic, and 94% felt it would be possible to incorporate simulation into their training. Conclusions Immediate improvements in knowledge and confidence in managing postpartum hemorrhage were evident following a simulation exercise. The simulation was well received and was considered an effective training method.