Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Residents/Medical Students HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Six obstetricians with significant experience in operative deliveries supervised and taught residents on labor and delivery, including the use of forceps

Intervention Results: There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries

Conclusion: Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.

Setting: Mt. Sinai Hospital

Population of Focus: All patients with term singleton vertex gestrations

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education Educational Material (Provider) Residents/Medical Students

Intervention Description: The intervention described by the article to increase postpartum screening was a 15-minute slide presentation with essential topics, including content on antepartum and postpartum depression focusing on signs, symptoms, screening, and treatment as well as antepartum maternal depression education highlighting the importance of understanding health literacy

Intervention Results: The results of the study showed that there was an increase in mean change over time for knowledge, self-efficacy, and motivation among medical and nurse practitioner students. The second null hypothesis was rejected, indicating that there was a significant increase in motivation levels from before to after the intervention. However, there was no significant difference between medical and nurse practitioner students, and student profession did not moderate the outcome effect

Conclusion: An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Study Design: The study design/type is a quasi-experimental study design

Setting: University of South Florida, College of Nursing and College of Medicine

Population of Focus: he target audience for the study was medical and nurse practitioner students who had completed the women's health/obstetric course within the curriculum, had self-identified ability to use the online technology platform/intervention, had access to an Internet-enabled device capable of accessing the online intervention, and were fluent in the English language

Sample Size: The sample size of this study was 71 participants, including 19 medical students and 52 nurse practitioner students

Age Range: The age group of the participants is not explicitly mentioned in the given texts. However, it is stated that medical students tended to be younger than nurse practitioner students

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER Patient Reminder/Invitation Incentives HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education Residents/Medical Students

Intervention Description: Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.

Intervention Results: After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64–2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40–3.02; P < 0.001). Our clinic’s CCS rate improved from 70% to 75% after the 18-month intervention.

Conclusion: The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.

Setting: Urban academic internal medicine clinic

Population of Focus: Women ages 21-64 eligible for cervical cancer screening

Intervention Components (click on component to see a list of all articles that use that intervention): Residents/Medical Students Provider Training/Education HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments.

Intervention Results: Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.

Conclusion: All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education Residents/Medical Students PROFESSIONAL_CAREGIVER Education/Training (caregiver)

Intervention Description: This study consisted of two experiments: 1) Medical students were taught safe sleep practices using behavioral skills training (BST) with an emphasis on sleep positioning (supine), surface, and items in the crib). The training included instruction, modeling, rehearsal, and feedback. 2) Using a pyramidal BST, medical students were trained to teach others safe sleep practices.

Intervention Results: Results indicated high procedural integrity scores following training and generalization of skills.

Conclusion: Pyramidal BST participants were provided with a training manual that included a written protocol of the training procedures, a checklist of the training components, data sheets, a safe infant sleep brochure, and a list of common questions about safe infant sleep with corresponding answers. Responses were examined pre- and post-training using a multiple-baseline design.

Setting: Urban university

Population of Focus: Medical students

Intervention Components (click on component to see a list of all articles that use that intervention): Residents/Medical Students Provider Training/Education

Intervention Description: Implementation of an annual influenza immunization workshop including immunization education, simulated practice, and peer influenza immunization

Intervention Results: Participants were more likely to report confidence in immunization skills than nonparticipants. Resident-administered immunizations increased from 1 in the 3 years preceding workshop implementation to 74 during the 2019 to 2020 academic year. Significantly, more ACGME survey respondents reported preparedness to immunize after workshop implementation.

Conclusion: Implementation of an influenza immunization workshop provides an innovative opportunity to increase resident preparedness performing an ACGME-required procedure while also helping ensure programs remain compliant with influenza requirements.

Study Design: Prospective cohort study

Setting: Pediatric residency program in a tertiary academic center

Population of Focus: Pediatric residents

Sample Size: 59 residents participated in the workshop - Age range: Not specified

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE Provider Training/Education HOSPITAL Collaboratives Residents/Medical Students

Intervention Description: In accordance with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Training Program guidelines, residents were required to develop competency in outlet, low, midcavity, and rotational instrumental birth. In 2010, the Monash Health Centre in Victoria Australia implemented a formalized lecture series and mannequin simulation training preceding mandatory instrumental credentialing for all obstetric residents. Credentialing required residents to be directly supervised by senior obstetricians in human instrumental birth until assessed as competent for unsupervised practice (remote supervision). Residents could only be credentialed in vacuum birth after being first credentialed in forceps birth. All residents were required to meet with training supervisors at 3-monthly intervals to review credentialing documents and implement remedial pathways if credentialing was not achieved in an appropriate timeframe.

Intervention Results: There were 72,490 births from 2005 to 2014 at Monash Health, of which 8,789 (12%) were attempted instrumental vaginal births. After the intervention, rates of forceps births increased [autoregressive integrated moving average coefficient (β) 1.5, 95% confidence interval (CI) 1.03-1.96; P<.001], and vacuum births decreased (β -1.43, 95% CI -2.5 to -0.37; P<.01). Rates of postpartum hemorrhage decreased (β -1.3, 95% CI -2.07 to -0.49; P=.002) and epidural use increased (β 0.03, 95% CI 0.02-0.05; P<.001). There was no change in rates of unsuccessful instrumental births (β -0.39, 95% CI -3.03 to 2.43; P=.83), intrapartum cesarean delivery (β -0.29, 95% CI -0.55 to 0.14; P=.24), third- and fourth-degree tears (β -1.04, 95% CI -3.1 to 1.00; P=.32), or composite neonatal morbidity (β -0.18, 95% CI -0.38 to 0.02, P=.08). Unsuccessful instrumental births were more likely to be in nulliparous women (P<.001), less likely to have a senior obstetrician present (P<.001), be at later gestation (P<.001), and involved larger birth weight neonates (P<.001).

Conclusion: A policy of ensuring obstetric forceps competency before beginning vacuum training results in more forceps births, fewer postpartum hemorrhages, and no increase in third- and fourth-degree perineal injuries or episiotomies.

Setting: Monash Health, an academic health science center in Melbourne, Australia

Population of Focus: All patients with attempted instrumental births