Closing the gap in breech delivery competence: A multi-country analysis of simulation-based training for breech births.

OBJECTIVE

This study describes the vaginal breech delivery assessment tool used within the Intensive Course in Obstetric Emergencies (ICOE) and assesses changes in performance following standardized simulation-based training.

METHODS

This retrospective observational study analyzed pre- and post-training scores from the vaginal breech delivery station of 16 ICOE courses conducted in Malaysia and six regional countries between May 1, 2022, and January 31, 2025. Doctors who completed both assessments were included. The station assessed four components using the Testing Tool for Integrated Professional Skills (TIPS): delivery of the buttocks, shoulders, and head and a global assessment score, with a maximum total score of 10.

RESULTS

A total of 357 doctors were included, of whom 142 were from Malaysia. Among Malaysian doctors, the mean total score increased from 5.3 before training to 9.0 after training. Improvements were observed across all assessed components, with an overall improvement of 71.3%. Both medical officers and specialists improved, although medical officers demonstrated greater relative gains despite lower baseline scores. Across Malaysia and regional countries, baseline performance varied, but post-training total scores improved overall, with a mean post-training score of 8.4 out of 10. Larger percentage improvements were generally seen in cohorts with lower baseline scores.

CONCLUSION

Standardized simulation-based training for vaginal breech delivery was associated with short-term improvements in simulated technical performance across diverse clinical and regional settings. Further work is needed to validate the assessment tool, assess long-term skill retention, and determine whether simulation-based performance gains translate into improved maternal and neonatal outcomes.