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Stanford University School of Medicine

Teaching Chinese clinicians about maternal hemorrhage management

For the last three years, thanks to an ongoing effort with China's Maternal and Child Health Association, Stanford's Center for Advanced Pediatric and Perinatal Education (CAPE) has provided instruction to Chinese physicians and nurses on patient care and the methodology of simulation-based training and debriefing. Last month, 16 trainees came to campus for a three-day program focused on the management of maternal hemorrhage; they then headed home to share what they learned with colleagues and trainees in their hospitals and those from outlying communities.

"It's been really rewarding not only seeing their progress while they're here with us, but knowing that now they're going back and they're spreading the way we train people at CAPE to other folks at home," said Lou Halamek, MD, director of CAPE. "We know the effects of our program are literally being extended to people that are caring for millions of newborns."

Chinese culture is hierarchical in nature, and this is also true of their health-care system, where great deference is extended to senior physicians. This hierarchy can create problems in acknowledging and addressing errors. By contrast, in the United States, junior clinicians may be encouraged to divide the workload and challenge decisions if they believe that someone in authority has made a mistake. CAPE instructors began the program with a dialogue about these cultural differences and their potential effect on patient care.

Julie Arafeh, RN, MSN, senior simulation specialist and instructor at CAPE, observed that when Chinese participants watched a recording of their performance during simulated clinical scenarios they learned how to improve their teamwork and communication. "Adding the team aspect accelerates what you can do as far as perfecting the delivery of care and making sure you're giving the best care possible," Arafeh said. "You can tell from the expressions on their faces when they leave just how valuable they have found this to be."

In its first two years, the program focused on training in neonatal resuscitation; the emphasis on maternal emergencies such as postpartum hemorrhage was new for 2017. Arafeh and colleagues from the Departments of Obstetrics & Gynecology and Anesthesiology, Perioperative and Pain Medicine crafted the program using recommendations from the World Health Organization and guidelines in use at Lucile Packard Children's Hospital Stanford. Pertinent documents were translated into Mandarin, allowing the participants to better understand how hemorrhage is managed in California, where maternal mortality rates are among the lowest in the United States.

Halamek speculates that this training may be especially useful now given the dissolution of China's "one-child policy" in October 2015. Because couples are now allowed to have two children, China's National Health and Family Planning Commission reported that there were 1.31 million more births in 2016 compared to 2015 (or a 7.9 percent increase). Many women are now having their second child well into their fourth or fifth decade of life, increasing their risk for complications of labor and delivery.

In order to strengthen processes for managing postpartum hemorrhage, Arafeh stressed the value of continuous quality improvement, which has been emphasized in California.  ""Let's review what happened. What didn't go as well? Let's fix that.' That's part of what we're trying to impart to them because it has been very successful in this state."

Previously: New obstetric hemorrhage tool kit released today
Photo by Manli Huang and Shucha Xing

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