Initial Evaluation of TeaM-L&DSim: A Simulation-Based Interdisciplinary Training Program for Labor and Delivery Teams in Resource-Variable Settings.

Abstract

Background: Simulation-based interdisciplinary training improves perinatal outcomes, but scalable and adaptable models for diverse labor and delivery (L&D) settings remain limited. The TeaM-L&DSim (Interdisciplinary Training for Patient Safety and Quality Care in Modern Labor & Delivery Simulation) program was developed by the No Pain Labor & Delivery-Global Health Initiative, combining nontechnical and technical simulation training, to enhance team functions, clinical decision-making, emergency preparedness, and complex care in resource-variable maternity care environments.

Methods: We implemented TeaM-L&DSim using a mixed-methods quality improvement framework nationally at six training hubs in the first year, with obstetricians, anesthesiologists, neonatologists, midwives/nurses, and hospital administrators from 52 hospitals in China. The program emphasized three educational innovations: the Three Co(re) Domains (Collaboration, Cognition, and Competence), the 4P Strategy (Prevision, Prophylaxis, Preparedness, Prompt responses), and a cascading mentorship model for trainer development. Training included 27 standardized simulation modules delivered through hybrid virtual-physical formats. Evaluation was structured using the four levels of the Kirkpatrick model (reaction, learning, behavior, and results). Data sources included pre/post-training surveys, voluntary feedback, site-level implementation audits, and observational reports.

Results: Ninety-seven percent of participants reported that the training met or exceeded expectations. Self-reported outcomes included improved interdisciplinary communication (92.7%), greater emergency response confidence (88.2%), and clearer role understanding (90.5%). A one-year follow-up survey with 29% response rate indicated 72% of respondents reported changes in personal practice, while 43% reported institution-initiated protocol modifications. These changes saw greater impact in Level 3A hospitals. The program demonstrated feasibility across both urban academic and rural hospitals, with early reports noting enhanced team dynamics and emergency response times.

Conclusions: TeaM-L&DSim is a scalable, interdisciplinary simulation program that improved team-based clinical competencies in L&D units, better effective in Level 3A facilities. More data are needed to understand adaptation to lower resource settings. This model holds promise for broader dissemination in global maternal safety initiatives.