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Stanford obstetricians take medical simulations to Central America

Stanford obstetricians are using simulation training to help colleagues in Central America learn new techniques to treat childbirth emergencies.

Training other physicians to handle obstetric emergencies has shown Katherine Bianco, MD, the value of nudging people out of their comfort zones.

Since 2016, Bianco, a high-risk obstetrician at Lucile Packard Children's Hospital Stanford, has traveled regularly to Central America with a Bay Area-based nonprofit called GO MOMS to teach physicians, nurses and medical residents the best techniques for treating serious complications of childbirth.

The Global Outreach: Mobile Obstetrics Medical Simulation and Gynecologic Surgery team, which goes by GO MOMS, uses simulation training -- everyone acts out the roles they would take in a real emergency -- to rehearse responses to such crises as maternal hemorrhage during childbirth.

'The first simulation is always a little hard," said Bianco, who made the trip with colleagues from Stanford's Department of Obstetrics & Gynecology. "It's like asking a doctor to get on stage. It's hard not to be self-critical. We watch the video tape and people say 'I didn't do this. I forgot to call for that.'"

Simulation training originated in the aviation industry, and Stanford's Center for Immersive and Simulation-Based Learning was an early leader in bringing the concept to medical education. The university's Center for Advanced Pediatric & Perinatal Education extended the use of simulation to train pediatric and obstetric providers at Packard Children's. It's a good fit for obstetrics, a field in which emergencies are fairly rare and unfold quickly. Although it has been widely accepted at major U.S. medical centers for several years now, the approach is often new to the physicians with whom Bianco interacts.

To help participants feel more comfortable with simulations, GO MOMS volunteers remind them that the purpose is to help everyone communicate better. "The idea is not to punish people for doing something wrong," Bianco said. "After people get over the first hump, they really buy into simulation and want to do it again."

At a medical conference in Guatemala City, Katherine Bianco, MD, left, trains medical student Maribel De Leon in a surgical technique to stop postpartum hemorrhage.

GO MOMS was founded in 2013 by Bianco's colleague, Kay Daniels, MD, who directs obstetric simulation training at Stanford Children's Health. Daniels wanted to address maternal death rates in Central America, which have historically been much higher than in the United States.

GO MOMS uses a "train the trainers" model: Their volunteers travel to Central America a few times a year to teach obstetricians who are in leadership roles there. The local experts, in turn, spread knowledge to nearby colleagues. So far, the teams have worked in Nicaragua, Guatemala and Costa Rica. They've also offered training in Mississippi, which has higher maternal mortality rates than many other U.S. states, and are expanding next year to two locations in India.

The organization is conducting research to measure the success of its training sessions, offers volunteer and research opportunities for U.S. medical students, and plans to facilitate exchanges between medical students and residents from Guatemala and the United States.

"I'm from Venezuela, so I understand the culture and language of the region, and bringing the knowledge back is very exciting to me," Bianco said. "I feel like this is why I went to med school, why I'm a doctor. In this work, I really get to see the power of education and how it can impact maternal health."

Images courtesy of Katherine Bianco, MD

Katherine Bianco, MD, from left, clinical research coordinator Elizabeth Sherwin, and Kay Daniels, MD, Obstetrical Simulation Program director and founder of GO MOMS, surrounded by medical records in Guatemala City hospital. Their review of the charts was designed to measure the impact of GO MOMS educational program on patient outcomes.

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