TY  - JOUR
AU  - van Tetering, Anne A C
AU  - de Vries, Ella L
AU  - Ntuyo, Peter
AU  - van den Heuvel, E R
AU  - Fransen, Annemarie F
AU  - van der Hout-van der Jagt, M Beatrijs
AU  - Namagembe, Imelda
AU  - Byamugisha, Josaphat
AU  - Oei, S Guid
PY  - 2025
DA  - 2025/5/9
TI  - Mono-Professional Simulation-Based Obstetric Training in a Low-Resource Setting: Stepped-Wedge Cluster Randomized Trial
JO  - JMIR Med Educ
SP  - e54911
VL  - 11
KW  - obstetric
KW  - simulation
KW  - training
KW  - low income
KW  - middle income
KW  - LMIC
KW  - simulation training
KW  - medical education
KW  - mono-professional
KW  - obstetric training
KW  - low-resource setting
KW  - low-income setting
KW  - stepped-wedge
KW  - RCT
KW  - obstetric care
KW  - pregnancy care
KW  - Africa
KW  - maternal
KW  - perinatal
KW  - outcome
KW  - hospital
KW  - train-the-trainer
KW  - facilitator
KW  - trainer
KW  - learner
KW  - mortality rate
KW  - randomized controlled trial
AB  - Background: Emergency obstetric simulation-based training has increasingly been used to improve emergency obstetric care provision in sub-Saharan Africa. For determining the optimal methodology for effective training sessions in resource-constrained settings, it is crucial to conduct high-quality research. Objective: We aim to investigate the impact of a train-the-trainer model for providing technology-enhanced, mono-professional, simulation-based training in obstetrics in a resource-constrained setting on maternal and perinatal outcomes. Methods: A stepped-wedge cluster randomized trial was conducted from October 2014 until March 2016 at the medium- to high-risk ward at Mulago National Referral Hospital, Uganda, with an annual delivery rate of over 23,000. The intervention consisted of a train-the-trainer model in which training was cascaded down from master trainers to local facilitators (obstetric senior staff members) to learners (senior house officers). The training of senior house officers was provided to 7 fixed clusters by a computer-generated random sequential roll-out. The training comprised a 1-day (8 h), mono-professional, simulation-based training in obstetrics, and half-day repetition training sessions targeted at every 7 weeks. Both medical technical skills and teamwork skills were taught. The primary outcome comprised a combined maternal and perinatal mortality rate. Secondary outcomes comprised the maternal mortality rate, the perinatal mortality rate, the percentage of births by vacuum extraction and cesarean section, and the Weighted Adverse Outcome Score. Results: Overall, there were 17,496 births. The combined mortality rate was 9.05% (95% CI 8.37%‐9.77%) in the intervention group, and 8.73% (95% CI 8.21%‐9.28%) in the control group (odds ratio [OR] 0.98, 95% CI 0.86‐1.12; P=.81). No statistically significant change was found in the maternal mortality rate (OR 0.80, 95% CI 0.27‐2.32; P=.68) or the perinatal mortality rate (OR 0.99, 95% CI 0.87‐1.13; P=.87). This study did not identify any difference in the percentage of vacuum extractions, the percentage of cesarean sections, or Weighted Adverse Outcome Scores. Conclusions: This train-the-trainer model for providing technology-enhanced, mono-professional, simulation-based training in obstetrics was not able to change maternal and perinatal mortality outcomes. This study, in combination with literature, suggests that future research should consider multiprofessional team training in obstetrics involving all staff within their units. Trial Registration: ISRCTN Registry ISRCTN98617255; https://www.isrctn.com/ISRCTN98617255 International Registered Report Identifier (IRRID): RR2-10.2196/17277 
SN  - 2369-3762
UR  - https://mededu.jmir.org/2025/1/e54911
UR  - https://doi.org/10.2196/54911
DO  - 10.2196/54911
ID  - info:doi/10.2196/54911
ER  -