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Open Access Study protocol

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

Franyke R Banga1*, Sophie E M Truijens1, Annemarie F Fransen1, Jeanne P Dieleman2, Pieter J van Runnard Heimel1 and Guid S Oei13

Author Affiliations

1 Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, P.O. Box 7777, Veldhoven, 5500 MB, The Netherlands

2 MMC Academie, Máxima Medical Centre, Veldhoven, The Netherlands

3 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

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BMC Medical Education 2014, 14:175  doi:10.1186/1472-6920-14-175

Published: 21 August 2014



Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome.


The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups.

Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers.


The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers.

Trial registration

The Netherlands National Trial Register, webcite, registered June 1, 2014

Multiprofessional; Simulation-based obstetric team training; Deliberate practice; Crew resource management; Quality of care