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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 I1,3
1Department of Obstetrics and Gynaecology, Kings College Hospital Denmark Hill London SE5 9RS, 2Croydon University Hospital, London, 3MaTI - Maternity training International, London
Objectives
Methods
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.
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.
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.
Below is page 2 of the questionnaire
How well would you fare?
Conclusions
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?
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.
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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
1. Green top guideline no 42 second edition
(2012) shoulder distocia
2. Green top guideline no 42 (2005) shoulder
dystocia