Objectives

1. Evaluation of healthcare professionals’ understanding of eponymous manoeuvres and mnemonics in emergency obstetric care provision. Jan H1,3, Guimicheva B1, Gosh S1, Hamid R2, Penna L Sarris I1,31Department of Obstetrics and Gynaecology, Kings College Hospital Denmark Hill London SE5 9RS, 2Croydon University Hospital, London, 3MaTI - Maternity training International, London Methods Objectives Conclusions Below is page 2 of the questionnaire How well would you fare? Mnemonics are memory tools and techniques for remembering information that is otherwise quite difficult to recall. An example would be the ABCD song taught in nursery. The idea behind them is to encode difficult-to-remember information in a way that is much easier to remember. Our brains evolved to code and interpret complex stimuli such as images, colors, structures, sounds, smells and language. These stimuli are used by us to make sophisticated models of the world we live in. Our memories store all of these very effectively. Unfortunately, a lot of the information we have to remember in modern life is presented differently – as words printed on a page. While writing is a rich and sophisticated medium for conveying complex arguments, our brains do not easily encode written information, making it difficult to remember. Shoulder dystocia, vaginal breech delivery and uterine inversion are emergencies that obstetricians and midwives are taught to manage using numerous eponyms. Shoulder dystocia and breech skills training should be trained every 6 months according to RCOG recommendations. The manoeuvres used are usually named after someone who became famous because of them many years ago. The names are usually complex last names or even groups of names such as the Mauriceau–Smellie–Veit manoeuvre. The names neither describes the procedure nor are quick and easy to remember to aid communication. 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 courses such as advanced life support in obstetrics(ASLO) and management of obstetric emergency and trauma, these mneumonics form a major part of their teaching. The HELPERR mneumonic being the most well known and used in the united kingdom. The tradition of medicine in overcomplicating what can be a very simple step may lead to problems in training those who don’t have strong literacy skills or who English is not their first language. In this study we aim evaluate whether eponyms and mnemonics are remembered, understood and applied by qualified doctors and midwives of all levels. 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 manoeuvres used in shoulder dystocia, vaginal breech delivery and the management of uterine inversion. They were also asked to match the correct manoeuvres with the corresponding eponym. The questionnaires were distributed at Kings College and Croydon University Hospitals London to fully qualified doctors and midwifes who are currently practicing in obstetric care. These were collected by hand, and the participants were asked not to confer or use references to aid them. The sheets were marked and the scores inputted into excel and analysed. A two tailed Fishers exact test was done when comparing results between groups. Though in principle, mnemonics are a good idea and they certainly work for ABCDs, they do not seem to be very effective in this situation. Our results highlight that despite health care professionals remembering the mnemonics tested, their meanings were remembered incorrectly and so limiting their usefulness. This finding, together with the poor correlation between the knowledge of emergency manoeuvres and their names, suggest that perhaps future teaching should concentrate on learning the manoeuvres rather than concentrating on mnemonics and eponyms. The latest RCOG guideline 1 now still uses eponyms but only in the description of the very commonly used McRoberts Manoeuvre. Most of the l other references to manoeuvres are by description. There are also no longer any mention of the HELPERR mnemonic as there was in the previous guideline. 2 This data supports the general move towards a more practical and simpler approach. Below is an example of the front page of the questionnaire. How many can you answer? 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). PALE SISTER was only familiar to 5 people with only 1 correctly identifying what the letters stood for. The average score for identifying the correct manoeuvres for shoulder dystocia was 83% vs 27% score for correctly matching the names (p<0.0001). The average score for identifying the correct manoeuvres for breech was 59% vs 24% for correctly matching the names (p<0.0001). The average score for identifying the correct manoeuvres for uterine inversion was 37% vs 7% for correctly matching the names (p<0.0001). References • Green top guideline no 42 second edition (2012) shoulder distocia • 2. Green top guideline no 42 (2005) shoulder dystocia