High Fidelity In Situ Shoulder Dystocia Simulation
Resident physicians, emergency department (ED) staff
Precipitous deliveries are high acuity, low occurrence in most emergency departments. Shoulder dystocia is a rare but potentially fatal complication of labor that can be relieved by specific maneuvers that must be implemented in a timely manner. This simulation is designed to educate resident learners on the critical management steps in a shoulder dystocia presenting to the emergency department. A special aspect of this simulation is the unique utilization of the “Noelle” model with an instructing physician at bedside maneuvering the fetus through the stations of labor and providing subtle adjustments to fetal positioning not possible though a mechanized model. A literature search of “shoulder dystocia simulation” consists primarily of obstetrics and mid-wife journals, many of which utilize various mannequin models. None of the reviewed articles utilized a bedside provider maneuvering the fetus with the Noelle model, making this method unique. While the Noelle model is equipped with a remote-controlled motor that automatically rotates and delivers the baby either to the head or to the shoulders and can produce a turtle sign and which will prevent delivery of the baby until signaled to do so by the instructor, using the bedside instructor method allows this simulation to be reproduced with less mechanistically advanced and lower cost models.1-5
At the end of this simulation, learners will: 1) Recognize impending delivery and mobilize appropriate resources (ie, both obstetrics [OB] and NICU/pediatrics); 2) Identify risk factors for shoulder dystocia based on history and physical; 3) Recognize shoulder dystocia during delivery; 4) Demonstrate maneuvers to relieve shoulder dystocia; 5) Communicate with team members and nursing staff during resuscitation of a critically ill patient.
High fidelity, in situ, Noelle model, precipitous delivery, shoulder dystocia.