Board 439 - Research Abstract High-Fidelity Low-Tech Team Training in Obstetric and Neonatal Emergencies in Rural Mexico Changes Provider Knowledge, Self-Efficacy, Team Coordination and Identifies Latent Systems Errors. (Submission #814)

Introduction/Background Obstetric and Neonatal simulation and team training have been shown to increase provider knowledge, self-efficacy and team coordination.1-4 However, limited resource countries like Mexico rarely have access to such trainings given the high-cost of simulation.5 PRONTO’s low-cost interprofessional training combines simulation best-practices, evidence-based obstetric and neonatal emergency management, Team STEPPS communication concepts and strategic planning for latent error prevention in a two step training designed specifically for resource limited settings.6 The goal of this study was to assess the effect of PRONTO training on participant knowledge, self-efficacy, teamwork and strategic goal achievement. Methods A cluster-randomized implementation trial of PRONTO training in community hospitals in Chiapas, Guerrero and Mexico State, Mexico including 24 hospitals which were paired and then randomized to intervention or control. Twelve intervention hospitals received PRONTO 2-step training (Module 1-Teamwork, neonatal resuscitation, obstetric hemorrhage and then two to three months later Module II-Teamwork, neonatal resuscitation, obstetric hemorrhage, preeclampsia and shoulder dystocia). PRONTO training includes in-situ high-fidelity hybrid simulation using a patient actress and the birth simulator PartoPantsR for maternal emergencies and the NeoNatalieR for neonatal resuscitation. Results Data collection included - baseline chart review, pre/post testing, chart review and birth observation at 4, 8 and 12 months post intervention, in both intervention and control sites. The Ethics review board of the National Institute of Public Health, Mexico, approved this study. Statistical analysis of training impact data used longitudinal fixed-effects and linear regression models to estimate changes in knowledge and self-efficacy and logistic regression was used to assess strategic goal achievement. A total of 436 professionals in multi-disciplinary teams were trained in the 12 intervention hospitals during 2020-2012. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p<0.001- 0.009) in all domains. Teamwork scores improved and were maintained from Module I to Module II training. On average hospitals established 12 goals (range 5 to 24), achieving on average 71% of goals. There was no association between high goal achievement and knowledge, self- efficacy, proportion of doctors or nurses in training, location of training or teamwork score. Conclusion PRONTO simulation and team training is effective in resource-limited settings. High-fidelity, low-tech simulation can improve provider knowledge and self-efficacy, help support interprofessional teams in identifying latent system errors and empower providers to make the changes necessary to effect sustainable change in practice and patient care. Making simulation accessible globally has the potential to save the lives of mothers and babies even in the most resource-limited settings. References 1. Ellis D, Crofts J, Hunt L, et al. Hospital, Simulation Center, and Teamwork Training for Eclampsia Management. Obstet Gynecol 2008; 111:723-31. 2. Eppich W, Howard V, Vozenilek J, Curran I. Simulation-based team training in healthcare. Sim Helathcare 2011; 6: S 14-S 19. 3. Pliego JF, Wehbe-Janek H Rajab, MH, Browning JL, and Fothergill RE. OB/GYN boot camp using high-fidelity human simulators: enhancing residents’ perceived competency, confidence in taking a leadership role, and stress hardiness. Simul Healthcare 2008; 3(2): 82-9 4. Merien A, van der Ven, J, Mol BW, Houterman S, Oei SG. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstetrics and Gynecology 2010; 115(5):1021-31. 5. Cohen, SR, Walker DM, Wong B, Cragin L. Self-efficacy change with low-tech, high-fidelity obstetrical simulation training for midwives and nurses in Mexico. Clinical Simulation in Nursing 2012; 8(1), 15-24. 10.1016/j.ecns. 2010.05. 004. 6. Walker DM, Cohen, SR, Estrada, F, Monterroso, ME, Jenny A, Fritz J, Fahey JO: PRONTOSM training for obstetric and neonatal emergencies in Mexico. Int J Gynaecol Obstet 2012;116(2):128-33. Disclosures Mexican National Institute for Women, WHO Implementation Platform Grant, Micronutrient Initiative, BMGF contract, Co-founder and Executive Director, PRONTO International NGO.