Over the past year, AzRHA has worked with the Arizona State Office of Rural Health (SORH) to bring obstetric simulation training to rural health professionals in Arizona.  In the rural communities visited, patients commonly travel 45-60 minutes to reach a facility with birthing services.  These trainings were offered to health professionals working at critical access hospitals without birthing services, but where women seek care in the case of a precipitous birth.  Nearly half of the participants were nurses, and a third were paramedics or emergency medical technicians.  The number of attendees by location and profession is detailed in the following table and chart. 

OB Simulation Training Dates, Facilities, and Number of Participants

Professional Discipline of OB Simulation Training Attendees

In speaking with rural health professionals, several mentioned that, because the volume of obstetric cases is very low, they have limited experience and skill gaps due to infrequent exposure or limited professional training.  Participants consistently described hands-on simulation training as realistic, memorable, and confidence-building.

“As far as I can remember, [my prior experience with obstetric training has] only been in class, so when I did my basic course coming into EMS, and then when I … attended my advanced EMT classes last year. And they weren't as in-depth as this was, it was just very, like, you know, briefly touched on, just, like, going over mother's history, a quick APGAR kind of thing. There was simulations in class, but again, not, like, a full in-depth [training].”

“I really like how the instructors are very positive, very straightforward. And a lot of them were very aware of the situations on the reservation, and what, both, like, ethical and, cultural. They're very knowledgeable about that. But the main thing that was… that stood out was the actual mannequin [inadible]. It's just, helping assist the baby dummy and mom, like, and then having us assist with that, With that delivery part. So just kind of having, like, that visual hands-on was the most helpful. Only because they made it realistic. I mean, they really lubed up that mannequin, and it was difficult to handle. Just, again, just being super realistic and not, [inaudible]-coating it in a way. But they were, they were very, very helpful.”

“[the most helpful part of the training was] Just, like, to remain calm. Like, just, like, the process. I like the simulation. It was, like, I mean, like, something to see. Especially, we never, like, seen childbirth before, like, it's… it's, like, a real model of, like, how fast everything goes.”

In one facility, a precipitous birth occurred shortly after the training, and health professionals felt prepared to assist.

“Yeah, and perfect timing, because [a precipitous birth] was so soon after the training, it was still fresh in everyone's minds.”

A clear takeaway is that simulation training, delivered on-site at rural critical access hospitals, is an effective way to improve confidence and experience in low-volume skills.  Beyond skill acquisition, simulation was described as reinforcing teamwork, clarifying role delineation, and strengthening communication. Several participants expressed a desire for expanded outreach and recurring sessions, suggesting perceived value in ongoing skill reinforcement within low-volume rural settings.  This partnership between AzRHA and the SORH demonstrates an effective model for future rural health training programs. 

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