Obstetrics and Gynecology Simulation and Global Health Initiatives

  • Emily Nicole Bernice Myer
  • Chi Chiung Grace ChenEmail author
Part of the Comprehensive Healthcare Simulation book series (CHS)


The increasing number of obstetrics and gynecology trainees and providers interested in global health experiences along with shortages of skilled health-care providers in lower resource settings creates important opportunities to incorporate simulation in global health work and in global health settings. Simulation can be used to prepare providers ethically, emotionally, and clinically for global health work. In addition, simulation can be used to augment the teaching of essential skills and introduce comparatively new technology to providers in resource-limited settings. Simulation aimed at lifesaving and quality-of-life measures has the potential to decrease maternal mortality and morbidity as well as deaths related to gynecologic cancers and unsafe abortions in any setting including areas with fewer resources. To ensure relevance and sustainability, factors to consider when adapting simulations and simulation curricula for any environment include making sure the supplies and content are adapted to the needs, culture, and resources of the specific health-care context. It is essential to coordinate with local partners in international settings to design simulation curricula both for preparations prior to international travel and for use in those settings.


Global health Simulation Low-fidelity Lower resource setting Pre-departure preparation Obstetric simulation Gynecologic simulation 

List of Abbreviations


Human immunodeficiency virus


Human papilloma virus


Long-acting reversible contraception


Loop electrosurgical excision procedure


Manual vacuum aspiration


Visual inspection with acetic acid


World Health Organization


Working Group on Ethics Guidelines for Global Health Training


  1. 1.
    Millar HC, Randle EA, Scott HM, Shaw D, Kent N, Nakajima AK, et al. Global Women’s health education in Canadian obstetrics and gynaecology residency programs: a survey of program directors and senior residents. J Obstet Gynaecol Can. 2015;37(10):927–35.CrossRefGoogle Scholar
  2. 2.
    Stagg AR, Blanchard MH, Carson SA, Peterson HB, Flynn EB, Ogburn T. Obstetrics and gynecology resident interest and participation in global health. Obstet Gynecol. 2017 Apr 4 [Epub ahead of print].Google Scholar
  3. 3.
    Crofts J, Winter C, Sowter M. Practical simulation training for maternity care—where we are and where next. BJOG. 2011;118(Suppl. 3):11–6.CrossRefGoogle Scholar
  4. 4.
    Pitt MB, Eppich WJ, Shane ML, Butteris SM. Using simulation in global health: Considerations for design and implementation. Simul Healthc. 2017;12(3):177–81.CrossRefGoogle Scholar
  5. 5.
    Robinson N, Stoffel C, Haider S. Global women’s health is more than maternal health: a review of gynecology care needs in low-resource settings. Obstet Gynecol Surv. 2015;70(3):211–22.CrossRefGoogle Scholar
  6. 6.
    Ekblad S, Mollica RF, Fors U, Pantziaras I, Lavelle J. Educational potential of a virtual patient system for caring for traumatized patients in primary care. BMC Med Educ. 2013;13(1):110.CrossRefGoogle Scholar
  7. 7.
    Nour N, editor. Obstetrics and gynecology in low-resources settings: a practical guide. Cambridge, MA: Harvard University; 2016.Google Scholar
  8. 8.
    World Health Organization. WHO guidelines: maternal, reproductive and women’s health [Internet]. [cited 2017 Mar 1]. Available from:
  9. 9.
    Johns Hopkins Berman Institute of Bioethics. Ethical Challenges in Short-Term Global Health Training [Internet]. [cited 2017 Feb 3]. Available from:
  10. 10.
    Consortium of Universities for Global Health. Global Health Training Modules [Internet]. [cited 2017 Mar 1]. Available from:
  11. 11.
    Nelissen E, Ersdal H, Østergaard D, Mduma E, Broerse J, Evjen-Olsen B, et al. Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting. Acta Obstet Gynecol Scand. 2014;93(3):287–95.CrossRefGoogle Scholar
  12. 12.
    University of Wisconsin System: SUGAR Project. [Internet]. [cited 2017 Mar 1]. Available from:
  13. 13.
    American College of Obstetricians and Gynecologists. OB-GYN Simulations Curricula [Internet]. [cited 2017 Mar 1]. Available from:
  14. 14.
    Pronto International. Pronto International [Internet]. Available from:
  15. 15.
    Laerdal. MamaNatalie Birthing Simulator [Internet]. [cited 2017 Mar 1]. Available from:
  16. 16.
    USAID K. Global Health eLearning Center [Internet]. [cited 2017 Mar 1]. Available from:
  17. 17.
    PROMPT Maternity Foundation. PROMPT [Internet]. [cited 2017 Mar 1]. Available from:
  18. 18.
    Laerdal. Mama-U [Internet]. Available from:
  19. 19.
    Crump JA, Sugarman J, Barry M, Bhan A, Gardner P, Koplan JP, et al. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83(6):1178–82.CrossRefGoogle Scholar
  20. 20.
    Zaidi MY, Haddad L, Lathrop E. Global health opportunities in obstetrics and gynecology training: examining engagement through an ethical lens. Am J Trop Med Hyg. 2015;93(6):1194–200.CrossRefGoogle Scholar
  21. 21.
    American College of Obstetricians and Gynecologists. Ethical considerations for performing gynecologic surgery in low-resource settings abroad. Committee Opinion No. 466. Obstet Gynecol. 2010;116:793–9.CrossRefGoogle Scholar
  22. 22.
    Mohamed-Ahmed R, Daniels A, Goodall J, O’Kelly E, Fisher J. “Disaster day”: global health simulation teaching. Clin Teach. 2016;13(1):18–22.CrossRefGoogle Scholar
  23. 23.
    World Health Organization. Maternal mortality fact sheet [Internet]. 2016 [cited 017 Mar 1]. Available from:
  24. 24.
    Ameh CA, Obgyn F, Van Den Broek N. Best practice & research clinical obstetrics and gynaecology making it happen : training health-care providers in emergency obstetric and newborn care. Best Pract Res Clin Obstet Gynaecol. 2015;29:1077–91.CrossRefGoogle Scholar
  25. 25.
    Fritz J, Walker DM, Cohen S, Angeles G, Lamadrid-Figueroa H. Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico. PLoS One. 2017;12(3):e0172623.CrossRefGoogle Scholar
  26. 26.
    Walton A, Kestler E, Dettinger JC, Zelek S, Holme F, Walker D. Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala. Int J Gynecol Obstet. 2016;132(3):359–64.CrossRefGoogle Scholar
  27. 27.
    PROMPT Maternity Foundation. Practical obstetric multi-professional training [Internet]. [cited 2017 Mar 1]. Available from:
  28. 28.
    Ashish KC, Wrammert J, Clark RB, et al. Reducing perinatal mortality in Nepal using helping babies breathe. Pediatrics. 2016;137(6):e20150117e.CrossRefGoogle Scholar
  29. 29.
    Debas HT, Donkon P, Gawande A, Jamison DT, Kruk ME, editors. Essential surgery. 3rd ed. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2015.Google Scholar
  30. 30.
    Mahmud A, Kettle C, Bick D, Rowley C, Rathod T, Belcher J, et al. The development and validation of an internet-based training package for the management of perineal trauma following childbirth: MaternityPEARLS. Postgrad Med J. 2013;89(1053):382–9.CrossRefGoogle Scholar
  31. 31.
    Cohen SR, Cragin L, Rizk M, Hanberg A, Walker DM. PartoPantsTM: The high-fidelity, low-tech birth simulator. Clin Simul Nurs. 2011;7(1):e11–8.CrossRefGoogle Scholar
  32. 32.
    Deganus SA. SYMPTEK homemade foam models for client education and emergency obstetric care skills training in low-resource settings. J Obstet Gynaecol Can. 2009;31(10):930–5.CrossRefGoogle Scholar
  33. 33.
    Illston JD, Ballard AC, Ellington DR, Richter HE. Modified beef tongue model for fourth-degree laceration repair simulation. Obstet Gynecol. 2017;129(3):491–6.CrossRefGoogle Scholar
  34. 34.
    Sparks RA, Beesley AD, Jones AD. The “sponge perineum:” an innovative method of teaching fourth-degree obstetric perineal laceration repair to family medicine residents. Fam Med. 2006;38(8):542–4.PubMedGoogle Scholar
  35. 35.
    Perosky J, Richter R, Rybak O, Gans-Larty F, Mensah MA, Danquah A, et al. A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa. Simul Healthc. 2011;6(1):42–7.CrossRefGoogle Scholar
  36. 36.
    Tunitsky-Bitton E, King CR, Ridgeway B, Barber MD, Lee T, Muffly T, et al. Development and validation of a laparoscopic sacrocolpopexy simulation model for surgical training. J Minim Invasive Gynecol. 2014;21(4):612–8.CrossRefGoogle Scholar
  37. 37.
    Tunitsky-Bitton E, Propst K, Muffly T. Development and validation of a laparoscopic hysterectomy cuff closure simulation model for surgical training. Am J Obstet Gynecol. 2016;214(3):392.e1–6.CrossRefGoogle Scholar
  38. 38.
    Tunitsky E, Murphy A, Barber MD, Simmons M, Jelovsek JE. Development and validation of a ureteral anastomosis simulation model for surgical training. Female Pelvic Med Reconstr Surg. 2013;19(6):346–51.CrossRefGoogle Scholar
  39. 39.
    Hong A, Mullin PM, Al-Marayati L, Peyre SE, Muderspach L, Macdonald H, et al. A low-fidelity total abdominal hysterectomy teaching model for obstetrics and gynecology residents. Simul Healthc. 2012;7(2):123–6.CrossRefGoogle Scholar
  40. 40.
    Hefler L, Grimm C, Kueronya V, Tempfer C, Reinthaller A, Polterauer S. A novel training model for the loop electrosurgical excision procedure: An innovative replica helped workshop participants improve their LEEP. Am J Obstet Gynecol. 2012;206(6):535.e1–4.CrossRefGoogle Scholar
  41. 41.
    Beard JH, Akoko L, Mwanga A, Mkony C, O’Sullivan P. Manual laparoscopic skills development using a low-cost trainer box in Tanzania. J Surg Educ. 2014;71(1):85–90.CrossRefGoogle Scholar
  42. 42.
    Lozo S, Eckardt MJ, Altawil Z, Nelson BD, Ahn R, Khisa W, et al. Prevalence of unrepaired third- and fourth-degree tears among women taken to the operating room for repair of presumed obstetric fistula during two fistula camps in Kenya. Int Urogynecol J Pelvic Floor Dysfunct. 2016;27(3):463–6.CrossRefGoogle Scholar
  43. 43.
    Utz B, Kana T, van den Broek N. Practical aspects of setting up obstetric skills laboratories—a literature review and proposed model. Midwifery. 2015;31(4):400–8.CrossRefGoogle Scholar
  44. 44.
    Fuchs KM, Miller RS, Berkowitz RL. Optimizing outcomes through protocols, multidisciplinary drills, and simulation. Semin Perinatol. 2009;33(2):104–8.CrossRefGoogle Scholar
  45. 45.
    Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368(9550):1908–19.CrossRefGoogle Scholar
  46. 46.
    Campbell M, Sahin-Hodoglugil NNPM. Barriers to fertility regulation: a review of the literature. Stud Fam Plan. 2006;37(2):87–98.CrossRefGoogle Scholar
  47. 47.
    Adler A, Ronsmans C, Calvert C, Filippi V. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013;13(1):246.CrossRefGoogle Scholar
  48. 48.
    World Health Organization. WHO Guidelines for Safe Surgery 2009. Who [Internet]. 2009;125. Available from:
  49. 49.
    Chao TE, Mandigo M, Opoku-Anane J, Maine R. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc Other Interv Tech. 2016;30(1):1–10.CrossRefGoogle Scholar
  50. 50.
    2020 FP. FP2020 Initiative [Internet]. [cited 2017 Mar 1]. Available from:
  51. 51.
    Ngo TD, Nuccio O, Pereira SK, Footman K, Reiss K. Evaluating a LARC expansion program in 14 Sub-Saharan African countries: a service delivery model for meeting FP2020 goals. Matern Child Health J. 2016;1:1–10.Google Scholar
  52. 52.
    Cleeve A, Faxelid E, Nalwadda G, Klingberg-Allvin M. Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda. Cult Health Sex. 2017;1058:1–15.Google Scholar
  53. 53.
    Cook S, de Kok B, Odland ML. “It”s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study. Health Policy Plan. 2017;32:305–13.PubMedGoogle Scholar
  54. 54.
    Kabagenyi A, Reid A, Ntozi J, Atuyambe L. Socio-cultural inhibitors to use of modern contraceptive techniques in rural Uganda: a qualitative study. Pan Afr Med J. 2016;25:1–12.CrossRefGoogle Scholar
  55. 55.
    Bowling CB, Gerer WJ, Bryant SA, Gleason JL, Szychowski JM, Varner E, Holley RLRH. Testing and validation of a low cost cystoscopy teaching model. Obstet Gynecol. 2010;116(1):85–91.CrossRefGoogle Scholar
  56. 56.
    Okrainec A, Henao O, Azzie G. Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries. Surg Endosc Other Interv Tech. 2010;24(2):417–22.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Emily Nicole Bernice Myer
    • 1
  • Chi Chiung Grace Chen
    • 1
    Email author
  1. 1.Department of Gynecology and ObstetricsDivision of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of MedicineBaltimoreUSA

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