Presentation by Victor Petrov at the International conference on Simulation-based training in medicine (Kyiv, Ukraine, March 19-20, 2015) http://motherandchild.org.ua/eng/SimConf-2015

1. Interdisciplinary simulation training
for obstetric and neonatal
emergency conditions
Victor Petrov
Mother&Child Institute,
Chişinău
Міжнародна конференція
«Симуляційне навчання в медицині»

2. Popn 3.5 M
*Moldova GDP per capita PPP
4520.56 US dollars in 2013
Births 38,000
* International human development indicators.
(http://hdrstats.undp.org/en/indicators/62006.html)

3. Phases of Perinatal health system reform
• 3 major phases:
– creation and strengthening (1998-2002)
– optimization (2003-2007)
– modernization (2006-2014)
• having prominently contributed to the reduction of
IM on account of ENM (by 50%).
Strengthening perinatal health Governmental Program
Promoting Quality Services in Perinatal Care Project
Moldovan-Swiss Modernising perinatal system Project

4. Health and system interventions implemented in
different stages of the system reform
Interventions
Phases of reform
I II III
Regionalized / referral system in 3 levels 
National policies in perinatal health  
Endowment maternities with equipment  
Monitoring system of MNH using Babies matrix 
EB cost-effective interventions implementation  
Assessment of maternities using WHO questionnaires: 2003-7 
Clinical protocols in Obstetrics & Neonatology  
Community mobilisation: 2 national campaigns, Family Clubs  
Improvement QoC: regionalization, collaborative work in elaboration of clinical protocol, strategic
partnerships

QM: capacity building for QM teams, QI projects, translation of CPG into locally procedures, clinical
audit, benchmarking

Health Technology Management 
The QoC training portfolio within the PGE education programme:
simulation courses in Obs.&Neon. EmCare

Post-NICU Follow-up service 

5. Infant mortality rate, 1990-2013
18,5
16,3
13,2
2006. 2010. 2015.
•1990-1994 •2000-2004 •2013
•MDG
19
19,8
18,4
21,5
22,6
21,2
20,2 19,8
17,5 18,2
18,3
16,3
14,7 14,4
12,2
12,4
11,8
11,3
12,1
11,3
12,1
11,8
9,8
9,5
1990. 1991. 1992. 1993. 1994. 1995. 1996. 1997. 1998. 1999. 2000. 2001. 2002. 2003 2004. 2005. 2006. 2007. 2008. 2009. 2010. 2011. 2012. 2013.

6. Survival of neonates according to the birth weight:
2000 vs. 2013
0,814
0,841
0,919
0,945
0,96 0,959 0,956
0,934 0,947
0,961
0,98 0,985 0,988 0,991
0,0164
0,0538
0,317
0,369
0,399
0,437
0,504
0,522 0,601
0,777
85%
0,863
0,806
0,88
0
0,2
0,4
0,6
0,8
1
2000. 2005. 2009. 2010 2011. 2012. 2013.
1500-1999 2000-2499 500-999 1000-1499

7. 4 stages of medical simulation implementation in the
fields of Obstetrics and Neonatology
1. Planning
2. Preparation
3. Training of Ts
4. Step down trainings

8. 1. Planning stage
Simulation training course in ObstEmCare, Simulation Centre, Basel University Hospital, 2011
Simulation training course in NeonEmCare,
Medical University, Iasi, Romania, 2012
Simulation training course in Obst&NeonEmCare, Federal Centre of
Obstetrics, Gynecology&Perinatology, “V.Culakov”, Moscow, 2012

9. 2. Preparatory stage: creation of SimLab at
Mother&Child Institute, 1

10. 2. Preparatory stage: technical trainings, 2

11. 2. Preparatory stage, 3

12. 3. Trainings of Trainers stage, 1
Simulation training on Newborn Resuscitation,
with Dr. R. Pfister, HUG, Switzerland
Simulation training on Obstetrical Emergency Care,
with team of CESIMED, Porto, Portugal

13. 3. TofTs stage. Training of bioengineer
in SimulHUG, 2
• 3,5 days training in SimulHUG units: obstetrics, neonatology,
pediatrics and adults, getting acquainted with the mannequins
functioning, participation at 2 simulation trainings, scenarios
analysis.

14. 4. Step down training stage for multidisciplinary
teams
During the Moldovan-Swiss project time there were trained 380 specialists, which makes up 50,1% of
professionals working in PC s of level III and II. 184 specialists from Transnistrian region were trained
at SimLab with the support of EU and SDC.

15. 4. Step down mobile trainings in Newborn
resuscitation
• Benefits: a greater access for the staff from peripheral
maternities.
• The courses take place in conditions in which specialists from
peripheral maternities activate.

16. Simulation course in Newborn resuscitation
Course agenda
• 09:00 Registration of participants
• 09:10-09.30 Theoretical presentation
• 09:30-10:00 Presentation of mannequin’s functions
• 10.00-10.30 Use of a simple mannequin to practice
resuscitation maneuvers
• 10.30-11.30 Scenario with debriefing
• 11:30-12.00 Break
• 12:00-13:00 Scenario with debriefing
• 13:00-14:00 Lunch break
• 14:00-15:00 Scenario with debriefing
• 15:00-15:30 Break
• 15:30-16:30 Scenario with debriefing
• 16:30-17:00 Plenary discussion: what to improve.
Closure. Handing of certificates
16 specialists:
per a multidisciplinary
team of 4 specialists from
a maternity
composed of a
neonatologist,
obstetrician, midwife and
nurse.

17. Simulation course in Obstetrical emergencies
10-12 specialists:
per a multidisciplinary team
of 3-6 specialists from a
maternity
composed of a
anesthesiologist, medical
assistant, 1-2 obstetricians,
1-2 midwifes and nurse.
Course agenda (2,5 days)
• 09:00 Registration of participants
• 09:10-09.30 Introduction in simulation course
• 09:30-10:30 Presentation of mannequin’s functions
• 10.00-10.30 Use of a simple mannequin to practice
resuscitation maneuvers
• 10.30-11.30 Scenario with debriefing
• 11:30-12.00 Break
• 12:00-13:00 Scenario with debriefing
• 13:00-14:00 Lunch break
• 14:00-15:00 Scenario with debriefing
• 15:00-15:30 Break
• 15:30-16:30 Scenario with debriefing
• 16:30-17:00 Plenary discussion: what to improve.
Closure. Handing of certificates

18. Simulation course in Obstetrical emergencies
• Day 3
• 09:00 – 09:05 ->>> FILM Mannequin;
• 09:10 – 09:40 ->>> REVIEW (Petrov V.);
• 09:45 – 09:10 ->>> ECLAMPSIA, Scenario 1 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 09:15 – 09:45 ->>> ECLAMPSIA, Theory (Coşpormac V.);
• 09:50 – 10:30 ->>> ECLAMPSIE, Debriefing 1 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 10:35 – 11:00 ->>> COURSE. Leader (Iliadi C.);
• 11:00 – 11:15 ->>> Coffee Break ;
• 11:20 – 11:30 ->>> FILM Orchestra;
• 11:35 – 12:00 –>>> ECLAMPSIA, Scenario 2 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 12:05 – 12:30 ->>> ECLAMPSIA Debriefing 2 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 12:35 – 12:50 ->>> ECLAMPSIA, Scenariul 3 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 12:55 – 13:00 ->>> ECLAMPSIA Debrifieng 3 (Coşpormac V., Bejenaru S., Stasiuc V.);
• 13:00 – 14:00 ->>> Lunch break;
• 14:00 – 14:15 ->>> COURSE 6 , Hat (Iliadi C.);
• 14:20 – 14:40 ->>> HPP, Scenario 1 (Diug V., Iliadi C.);
• 14:45 – 15:15 - >>> HPP, Theory (Diug V.);
• 15:20 – 16:00 ->>> HPP, Debriefing 1 (Coşpormac V., Iliadi C., Diug V.);
• 16:00 – 16:15 ->>> Coffee Break ;
• 16:20 – 16:40 –>>> HPP, Scenario 2 (Iliadi C., Coşpormac V., Diug V.);
• 16:45 – 16:55 ->>> HPP 2, Debriefing 2 (Iliadi C., Coşpormac V., Diug V.);
• 16:55 – 17:00 ->>> Conclusions

19. Teamwork, communication

20. Strengthening knowledge and
practical skills

21. More practice, less theory

22. Self-assessment of own actions

23. Eclampsia

24. Eclampsia

25. PPH

26. PPH

27. PPH

28. Neonatal CPR

29. Neonatal CPR

30. Benefits of simulation cources
• strengthening practical skills of participants,
• discussion of each action with team and trainers,
• self-evaluation of own actions,
• good knowledge of managing algorithms in
frequently met emergencies,
• cultivation of decision making skills in participants,
• opportunity to participate in rare clinical cases.

31. Main challenges
For trainers
• lack of work experience in
this field and lack of a
standard methodology of
teaching, which has been
improved in time;
• related to the elaboration of
scenarios for
multidisciplinary teams by
including compartments
from different disciplines;
For participants
• initially skeptical
participants’ attitude
towards the course;
• perception of mannequin as
a real patient;
• insufficient involvement in
the course of decision
making persons.

33. The learned lessons
- Partner support
- Good collaboration with bioengineers
- Adaptation of different styles of working /
approaches of trainers taking into account their
speciality
- Strengthening of knowledge and practical skills
- Internal motivation of trainees for further
improvement of knowledge
- Minimising stress in real situation
- Reorganisation of working activity

34. Initial skeptical attitude of the participants
• The organizers had to overcome the initial
skeptical attitude towards participants during
the simulation itself.
• However, after the training course,
participants shared opinion that "... positive
experience should be repeated at least once
a year".

35. Future Steps in SimLab
• to train multidisciplinary teams from the first
level maternities, inclusively through mobile
simulation courses;
• to develop and implement new scenarios;
• to train new trainers;
• to accredit the existing training courses and
modules for CME;
• to develop courses and scenarios for
paramedics.

36. Special acknowledgments!
Adriani M. Hilbert & Georgette Bruchez Ana Reynolds
Petru Stratulat Riccardo Pfister

37. Thank you for your attention!