Shoulder Dystocia and Neonatal Resuscitation: An Integrated Obstetrics and Neonatology Simulation Case for Medical Students

A. Student Instruction Sheet

This document provides scenario-specific instructions for medical students assigned obstetric and pediatric roles during a simulated high-risk delivery involving shoulder dystocia. Learners are expected to obtain a focused history, perform a clinical assessment, initiate management, and communicate effectively through an interprofessional handoff when consultation is required. The sheet outlines role expectations and time limits for participation in both the obstetric management and neonatal resuscitation components of the simulation.

B. Patient Chart Note

This document presents a simulated prenatal and labor chart for a 38-year-old gravida 2 patient at 38 weeks gestation presenting with contractions and incomplete prenatal follow-up. It includes clinical history, prenatal care details, and labor progression information intended to guide learner assessment and decision-making during the scenario. The chart serves as a foundational data source for diagnosing labor complications and anticipating potential delivery emergencies.

C. Prebrief and Debriefing Materials

This document outlines structured guidance for facilitators conducting simulation prebriefing and post-scenario debriefing sessions. It emphasizes establishing psychological safety, clarifying learning objectives, and encouraging interdisciplinary communication without revealing the clinical diagnosis in advance. The debriefing framework supports reflective discussion of clinical reasoning, teamwork, and emergency management performance.

D. Simulation Image

This resource provides visual support for the simulation environment by depicting elements of the obstetric delivery scenario used during the case. It is intended to enhance realism and contextual understanding of the labor and delivery setting for participating learners. The image assists in orienting learners to patient positioning and clinical workflow during the simulated emergency.

E. Critical Actions Checklists

This document lists required clinical actions for managing shoulder dystocia and neonatal resuscitation within the simulation. It includes expectations related to history-taking, physical examination, labor evaluation, fetal monitoring interpretation, delivery preparation, and communication. The checklist is used for performance assessment and to ensure adherence to appropriate emergency management protocols.

F. Shoulder Dystocia Simulation Guide

This guide provides a structured narrative describing the ideal progression of the shoulder dystocia simulation scenario. It outlines expected learner behaviors, including patient evaluation, monitoring, delivery preparation, and recognition of obstructed fetal descent. The document supports faculty facilitation by defining critical decision points and appropriate clinical responses during the obstetric emergency.

G. Neonatal Resuscitation Simulation Guide

This guide details the expected management of a term infant delivered following shoulder dystocia who presents cyanotic, limp, and apneic. It directs learners to anticipate neonatal compromise, assign team roles, prepare equipment, and initiate appropriate resuscitative measures after birth. The scenario framework emphasizes timely assessment and execution of initial neonatal resuscitation steps.

Educational Summary Report (PDF)

This report describes the development and implementation of an interdisciplinary obstetrics and neonatology simulation integrating shoulder dystocia management with neonatal resuscitation training. It outlines the educational rationale for simulation-based learning in longitudinal clerkships and highlights objectives related to clinical reasoning, teamwork, and communication. The report also discusses structured debriefing and the role of simulation in improving learner preparedness for obstetric and neonatal emergencies.

Target Learners

This activity is intended for:

• Third- and fourth-year medical students participating in obstetrics and pediatrics clerkships

• Interprofessional learners including:

  • Obstetrics and Gynecology residents

  • Pediatric or Neonatal residents

  • Nursing students or labor and delivery nurses

• Learners with foundational knowledge of:

  • Normal labor progression

  • Basic obstetric delivery techniques

  • Initial neonatal resuscitation principles

Equipment Needed

Simulation Environment

• Labor and delivery simulation room or equivalent clinical skills space

• Obstetric birthing manikin capable of simulating shoulder dystocia

• Neonatal manikin capable of basic resuscitation interventions

Obstetric Equipment

• Fetal monitor (real or simulated)

• Delivery bed

• Obstetric delivery instrument set

• Towels and blankets

• Gloves and standard personal protective equipment

• Simulated patient chart

Neonatal Resuscitation Equipment

• Infant warmer

• Bag-valve-mask device (neonatal size)

• Oxygen source

• Suction device (bulb syringe or wall suction)

• Pulse oximeter

• Neonatal stethoscope

Facilitator Materials

• Prebriefing guide

• Critical actions checklist

• Debriefing framework

• Simulation case narrative

Estimated Time to Complete Activity