In 2015, more than 300,000 women died during pregnancy and immediately following childbirth.1这些死亡中有99％发生在发展中国家。2由Laerdal Medical资助的非营利组织Laerdal Global Health（LGH）制定了降低低资产社国家的母亲和婴儿死亡188体育直播比分率的计划。我们认为，可以从LGH的经验中学到很多东西，这些经验可以转移到高级课程的环境中。
LGH was founded in 2010. Working in partnership with Jhiepego, the American Academy of Pediatrics, and the Church of Latter-Day Saints, LGH has helped make tremendous improvements in the health of new mothers and newborns in developing countries. A study in Tanzania, for example, measured the success of the Helping Babies Breathe Program with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years.3这些在坦桑尼亚产生的相同解决方案在美国和其他地方也可以做到这一点。
早期新生儿死亡率的降低
reduction in fresh stillbirths
尽管在美国，医疗设施和专业培训更加先进，但总有改进的余地。每年在美国，由于怀孕或分娩并发症，每年约有700名妇女死亡。4世界卫生组织（WHO）计算出大约一半是可以预防的。5幸运的是，training using simulation is a proven way to identify and reduce preventable error.
在本文中，我们分享了如何将Laerdal Global Health及其合作伙伴的经验转移到您的培训环境中，以改善孕产妇和新生儿护理。
在低资源领域，教育工作者别无选择，只能做更多的事情。但是，在这种情况下，教学经验较少，激发了教育工作者返回课程设计和模拟的基础知识。
most educators would argue that learning goals are the most important element in any class. As a reminder,without purposeful learning goals, there is no desired outcome to unify you as the educator with your learners.
许多专家建议您从期望的结果开始。然后，使用聪明的相应地制定学习目标的框架。问问自己的学习目标是否是…
| specific | measurable | 一个可见 | r真实 | time绑定 |
LGH的目标是通过提供支持卫生工作者的工具和培训来帮助到2020年每年挽救40万人的生命。6通过明确定义组织的目标，LGH可以创建解决方案和计划以帮助您到达那里。您也可以通过使用智能方法来创建强大的学习目标以及随后实现强大的学习目标来为成功做好准备。
当您开始计划单个模拟时，请记住学习者的经验水平以及学习的设置。您可能没有专门的模拟实验室的资金 - 没关系！Consider the setting of LGH’s trainings in Tanzania and use that as inspiration to get creative with the existing resources, faculty, and equipment you have.
One study compared two simulations – one using a standardized patient at a local hospital and one using a high-fidelity simulator in a simulation lab. In both settings, there were equal improvements among the learners.7这证明了这一点模拟而不是模拟器的类型是开发学习者的关键。
每年在全球范围内，有1.4亿妇女分娩。8to improve the survival of new mothers and infants, healthcare professionals need to be given engaging and fulfilling training. Simulations that adhere to the best practices in adult learning can provide this. Not every situation requires high-fidelity to gain a high return on learning. Experts recommend matching the level of your simulation with the experience you need to create for effective learning to occur.
高保真模拟训练会导致表“发抖”endous improvements in learner’s skills acquisition. For this reason, many educators adopt a form of tunnel-vision towardonly高保真模拟和可以忽略ir desired outcome in the process. Those new to simulation may find funding such high-fidelity simulators challenging and those experienced in simulation may be blind to other, complimentary methods of teaching.
LGH的经验证明了低保真任务培训师和模拟器可以极大地提高学习者的技术技能和人际交往能力。没有电气要求或复杂的设置。通过与JHPIEGO合作开发的帮助母亲生存计划，我们看到产后出血降低了17％，保留胎盘降低了47％，降低了34％的胎盘静止病。9因此，您不应忽略低保真模拟作为选项。
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there are many simulation methods from which to choose...The key is selecting the technology or method that provides for active engagement with the learner.* |
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In the United States, the cost of maternity care exceeds 60 billion dollars, yet women are still dying during pregnancy or childbirth.10和，an estimated 60,000 women suffer complications that are near-fatal.11In response, some hospitals are beginning to implement more hands-on training to manage obstetric emergencies – and they are using simulation to accomplish this.
如果您的仿真程序无法访问全身分娩模拟器，则低保真模拟可能是答案。可以与标准化患者一起使用的分娩模拟器和任务培训师为学习者提供了真正的患者互动的机会。学习者还可以练习正常和复杂的交付的基本技能，以便他们准备在紧急情况下采取行动。
One study found that only 43% of learners could successfully address shoulder dystocia emergencies.12在模拟的肩膀难题场景之后，学习者在使用基本操作，良好的患者沟通和更高的成功交付率方面有所改善。13
Low-fidelity simulation is also a great supplement to your program if you做具有一个完全发出的分娩模拟器。全身模拟器的技术可能会淹没母亲劳动母亲的护理程序的学习者。在这种情况下，在向他们介绍更身临其境的培训经验之前，使用低保真分娩模拟器或任务培训师可以确保您的学习者对自己的技能充满信心。
LGH’s experience training midwives and other healthcare professionals in rural areas shows the impact low-fidelity solutions can have. Whether your simulation experience level is high or low – or your facility is large or small – low-fidelity simulation is something to consider.
创建现实的培训环境始终是一个挑战。再加上低资金，稀缺的教学资源以及有限的培训时间的复杂性，这可能会成为一个难题。LGH及其合作伙伴在世界各地亲眼目睹了这些挑战，并帮助医疗保健专业人员克服了这些挑战。
For many, simulation training solutions are an investment – not only in improved learning outcomes but also in the inevitable cost-savings and decreased liability to the institution. It’s important to remember that these cost-savings will be in the form of reduced harm and costs associated with harm, rather than from a direct profit.
我们的目的是培训医疗保健专业人员提供最高质量的护理，并且有一些例子可以降低成本……我们正在教医疗保健专业人员在升级之前接受事情。
Low-fidelity simulation has its place in the learning cycle. It can be a useful training method if your program does not have many funding options. High-fidelity simulation can be costly and will require a larger initial investment, but low-fidelity simulation can provide similar experiences with fewer resources.14和，低保真模拟可以帮助减轻诸如低教师专业知识和可用性之类的实施障碍。
In the United States, low-budget clinics and organizations planning community outreach can benefit from the same mentality of cost-consciousness. With so many hospital facilities closing in low-income neighborhoods, clinics are receiving an influx of high-risk patients.15to better prepare healthcare professionals in urban and rural clinics, the same task trainers and birthing simulators that have been used in low-resource countries should be a consideration in developing any training program.
除了低保真模拟器和任务培训师的负担能力外，它们非常易于使用。几乎没有模拟经验的教育者可以迅速学习如何设置场景并能够充分利用他们的教学时间。这种类型的培训效率使许多学生可以在一次学习课程中进行培训，并减少护理团队的时间。对于努力寻找时间进行培训的组织，我们建议低保真解决方案作为开始。
选择投资于财务范围内的低保真产品仍可能导致患者伤害的大幅减少。金宝搏官方app下载易用性和生产力只是教育者和学员的额外奖励。
在美国，与发达国家其他女性相比，妇女更有可能死于分娩或与怀孕有关的原因。16many hospitals do not conduct simulation, and it’s quite possible that one of the reasons is that they perceive simulation as an expensive endeavor requiring major facilities. Our experience with LGH shows that it does not have to be.
While Laerdal Global Health’s not-for-profit efforts are focused on low-resource countries, their insight and experience can be used to positively influence training within the U.S. Most importantly, their experience in various communities around the world verifies that simulation can be effective in any learning setting – as long as educators have clear objectives and the tools to match.
* Aebersold, M. (2018). Simulation-based learning: No longer a novelty in undergraduate education。在线护理问题杂志，23（2）。从...获得：http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Articles-Previous-Topics/Simulation-Based-Learning-Undergraduate-Education.html
**新泽西州医疗保健质量研究所。（2018）。与James Spaulding，BSN，RN，CCRN，SIM实验室协调员在St。彼得大学医院。从...获得：http://www.njhcqi.org/take-five-with-james-spaulding-bsn-rn-ccrn-sim-lab-coordinator-at-st-peters-university-hospital/
