First research project


We have conducted our first research project and are presenting it in Malasia at the 10th Annual international congress in Obstetrics and Gynaecology this June.  When we were writing our program and syllabus for training courses in low resource settings it occurred to us that one cannot simply take the same model used here in the UK and apply it abroad.  Training is very much reliant on the assumption of high literacy and the use of eponyms for very simple manoeuvres is extensive.  In fact we complicate things so much that perhaps its even too complicated for staff in the UK.

Because of the inherent difficulty in remembering eponyms and the cascade of procedures, mnemonics have been devised to aid our memory in the emergency situation. In this study we aimed to evaluate whether eponyms and mnemonics are remembered, understood and applied by qualified doctors and midwives of all levels in the UK.An anonymous questionnaire was devised collecting demographic data and information about the knowledge and clinical use of HELPERR and PALE SISTER mnemonics for shoulder dystocia. In addition, 3 extended matching questions (EMQ) evaluated participants’ knowledge of the correct maneuvers used in shoulder dystocia, vaginal breech delivery and the management of uterine inversion. They were also asked to match the correct maneuvers with the corresponding eponym. The questionnaires were distributed at a london teaching hospital and a district general hospital to fully qualified doctors and midwifes who are currently practicing in obstetric care.  The sheets were marked and the scores analyzed. A two tailed Fishers exact test was done when comparing results between groups. Click to see the results…

90 questionnaires were collected in total; 33 by doctors and 49 by midwives. 88% said they were familiar with the HELPERR mnemonic with 79% saying they used it in their practice. Of those who used it in their practice only 30% could correctly identify what all the letters stood for (p<0.0001). The average score for identifying the correct maneuvers for shoulder dystocia was 83% vs 27% score for correctly matching the names (p<0.0001). The average score for identifying the correct maneuvers for breech was 59% vs 24% for correctly matching the names (p<0.0001). The average score for identifying the correct maneuvers for uterine inversion was 37% vs 7% for correctly matching the names (p<0.0001).

Our results highlight that despite remembering the mnemonics tested their meanings were remembered incorrectly and so limiting their usefulness.  In addition, uterine inversion scores were poor overall.  The reason for this is that because it is such a rare emergency, it is not regularly drilled by all healthcare staff because of limited resources.  These findings, together with the poor correlation between the knowledge of emergency maneuvers and their names, suggest that perhaps future teaching should concentrate on learning the manoeuvres rather than concentrating on mnemonics and eponyms.

At MaTI we hope to come up with a new way of teaching and training that is simple,fun,  easy to learn, language independent and easy to remember.  We hope to test these ideas over the next 6 months in various randomised studies.