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Sir,

We read with interest the editorial comments1 on the article by Draycott et al.2 The authors2 reported improvements in neonatal outcome, specifically a reduction in the incidence of low Apgar scores and hypoxic ischaemic encephalopathy, following the introduction of obstetric emergency training within their unit. It is likely that these endpoints were chosen due to the ready availability of the data in lieu of more sensitive measures to demonstrate the impact of training on neonatal or infant development. We accept that retrospective analysis of data seldom provides an unambiguous answer to a definitive question, and the difficulty of measuring any clinical outcome after obstetric emergency training has to be acknowledged. Moreover, serious obstetric emergencies are thankfully rare, and clinical outcomes are influenced by many confounding factors, making the assessment of the effects of training difficult. The same problems are faced in the evaluation of outcome after aviation simulation training.

Draycott et al. did not demonstrate an improvement in infant morbidity but did present evidence to support the introduction of training that we find compelling. Moreover, such training is currently recommended by the UK Confidential Enquiries into Maternal and Child Health and is required by the Clinical Negligence Scheme for Trusts.

We support your concerns surrounding the attitude of consultants, compared with pilots, towards simulation training. However, when simulation training was introduced in the aviation industry it was to address the attitudes of the ‘Atlantic Barons’, which may mimic those of some current consultants. With an appropriate method of multidisciplinary training in obstetric emergencies and a change in learning culture, we hope that it will not take 50 years to redress this issue.

This letter is on behalf of the Simulation and Fire-drill Evaluation (SaFE) study group who are pleased to inform you of their randomised controlled trial, sponsored by the Department of Health’s Patient Safety Research Programme, evaluating different training modalities and interventions relating to obstetric emergencies. We look forward to submitting our results for publication later this year, answering some of the questions posed.

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