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Randomised controlled study to assess skill retention at 6 vs 12 months after simulation training in shoulder dystocia
  1. Menelik M H Lee,
  2. Chao Ngan Chan,
  3. Betty Y T Lau,
  4. Teresa W L Ma
  1. Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
  1. Correspondence to Dr Menelik M H Lee, Associate Consultant, Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong; menelik.lee{at}


Introduction Current evidence suggests annual training in the management of shoulder dystocia is adequate. The aim of this trial is to test our hypothesis that skills start to decline at 6 months after training and further decline at 12 months.

Methods In this randomised, single-blinded study, 13 obstetricians and 51 midwives were randomly assigned to attend a 1-hour mixed lecture and simulation session on shoulder dystocia management. Training was conducted on group 2 at month ‘0’ and on group 1 at month ‘6’. Their knowledge scores (primary outcome) were assessed before (pre-training), immediately after the training (at-training) and retested at month ‘12’ (post-training).

Results Two-way repeated-measures analysis of variance showed a statistically significant interaction between the testing time frame (pre-training, at-training and post-training) on the score (p<0.001), but no significant interaction between the groups on the score (p=0.458).

Compared to pre-training, the score increased after the simulation training (at-training) in both group 1 (8.69 vs 14.34, p<0.001) and group 2 (9.53 vs 14.66, p< 0.001), but decreased at 6 months post- training in group 1 (14.34 vs 11.71, p<0.001) and at 12 months post-training in group 2 (14.66 vs 11.96, p< 0.001). However the score was better than before the training. There was no significant difference in the post –training score (11.71vs 11.96, p=0.684) between both groups.

Conclusions Our study demonstrated that simulation training results in short-term and long-term improvement in shoulder dystocia management however knowledge degrades over time. Ongoing training is suggested at a minimum of 12 months’ interval for all members of the obstetrics team including midwives and doctors.

  • shouder dystocia
  • simulation training
  • Obstetrics
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  • Contributors MMHL: Implemented the trial, designed data collection tools, monitored data collection for the whole trial, wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the paper. He is the guarantor and the corresponding author. CCN: Implemented the trial and revised the paper. MATWL: Initiated the project, implemented the trial and revised the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Kowloon Central/Kowloon East Research and Ethics Committee, Hospital Authority, Hong Kong.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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