Expecting the Unexpected: to what extent does simulation help healthcare professionals prepare for rare, critical events during childbearing?

Pregnancy and childbirth presents both rare and critical events for which healthcare professionals are required to acquire and maintain competent clinical skills. In theory, a skill demonstrated using simulation will transfer into practice competently and confidently; the strength of simulation appears to lie in its validity with clinical context. Evidence shows that some professionals have difficulty responding appropriately to unexpected critical events and, therefore, there were two main aims: 1) to learn more about how healthcare practitioners develop skills in order to prepare for and respond to rare, critical and emergency events (RCEE) during childbearing, 2) to uncover healthcare practitioners’ experiences of simulated practice. An explanatory sequential mixed methods approach consisted of a quantitative systematic review combined with a framework analysis of curricula documentation. Subsequently, a conceptual framework of simulation was explored through qualitative inquiry with twenty five healthcare professionals who care for childbearing women. Attribution theory proved useful in analysing these experiences. Findings illustrated the multifaceted and complex nature of preparation for RCEE. Simulation is useful when clinical exposure is reduced, has the potential for practice in a safe environment and can result in increased confidence, initially. In addition, teamwork, the development of expertise with experience, debriefing and governance procedures were motivational factors in preparedness. Realism of scenarios affected engagement if they were not associated with ‘real life’; with obstetric focus, simulation fidelity was less important and, when related to play, this negatively influenced the value placed on simulation. The value of simulation is positioned in the ability to ‘practise’ within ‘safe’ parameters and there is contradiction between this assumption and observed reality. Paradoxically, confidence in responding to RCEE was linked to clinical exposure and not simulation and was felt to decay over time, although the timeframe for diminution was unclear. Overwhelmingly, simulation was perceived as anxiety provoking and this affected engagement and learning. Data highlights ambiguity between the theoretical principles of simulation and the practical application.