Date of Award

12-9-2024

Degree Type

Thesis

Degree Name

Master of Health Professions Education

First Advisor

Dr. Rukhsana Zuberi

Second Advisor

Dr. Tabassum Zehra

Third Advisor

Dr. Naveed Yousuf

Department

Educational Development

Abstract

Background: CTG is one of the most common modalities to assess fetal wellbeing in the last trimester and during labour. Inaccurate CTG interpretation and subsequent delay in clinical care are frequently cited as a cause of adverse neonatal outcomes in Obstetric patients. Studies suggest that errors in CTG interpretation frequently occur in labour wards, and improved training may alleviate these errors. The overall impact of CTG educational courses on neonatal outcomes has failed to show consistent improvement. Studies on CTG educational courses lack foundation of educational theories in course development, multi-modal instructional strategies for adult learning, and valid assessment strategies. This study aimed to assess the impact of a multimodal interprofessional CTG educational course on participants' 3-month delayed scores and its impact on the Decision to Delivery Interval of Emergency Cesarean Section and associated neonatal outcomes.
Methods: This quasi-experimental study involved administering an educational intervention (ICEC) to postgraduate OBGYN residents/resident medical officers, registered nurses, and midwives. The study was conducted in five Aga Khan University Hospital campuses. The course development was based on evidence-based principles of learning, assessment for learning, and feedback. The educational intervention had three components: the VLE Module, the Workshop Module, and the Refresher Module.
Results: There were 222 participants enrolled in the educational intervention. These participants attempted all three components of the course: the median pre-test score was 65.1%, which improved to 87% after the VLE module and workshop (p=0.0005). The delayed Refresher Module, conducted after three months, demonstrated a further increase of 7% in test scores which increased to 95%, and was significantly higher than the postworkshop score of 87% (p=0.02). The pre-and post-ICEC proportion of emergency Caesarean Sections performed for fetal distress within the 30-minute DDI was compared during work hours and off-working hours. Before the educational intervention, 18% of all emergency Caesarean sections performed due to fetal distress were within the standard DDI of 30 minutes during working hours. After the ICEC, the proportion of emergency Caesarean Sections performed within 30 minutes during working hours increased to 28.6%, and this improvement was statistically significant (p=0.036).
Conclusion: This study has shown that a 3-step effective interprofessional CTG Educational Course (ICEC) can significantly improve the knowledge of Obstetric nurses, midwives, and doctors. The educational intervention's multimodal approach prevented knowledge decay three months after the intervention and improved post-refresher module test scores. Improvement in nurses' CTG-related knowledge resulted in the timely involvement of doctors and appropriate decisions on CTG traces showing signs of fetal distress. This ultimately led to an increasing proportion of Emergency Caesarean Sections performed for fetal distress within the benchmark time of 30 minutes of DDI during working hours.

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1

Last Page

151

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