Paired-operator simulation training for intrauterine tamponade balloon placement: A feasibility study with integrated TeamSTEPPS assessment

BACKGROUND: Postpartum haemorrhage remains the leading cause of maternal mortality worldwide. Intrauterine tamponade balloons are increasingly used, but reported failure rates show considerable variability across studies. Individual studies showed substantial heterogeneity, with failure rates ranging from 4% to 39% depending on clinical context. This feasibility study evaluated paired-operator simulation training combining technical skills with TeamSTEPPS non-technical competencies. METHODS: This was an ancillary analysis of the PARTUM training session. Sixteen European obstetricians from three francophone countries (France N = 9, Belgium N = 5, Switzerland N = 2) in randomised pairs participated in two simulation sessions three months apart. Following theoretical training and TeamSTEPPS instruction, pairs performed intrauterine tamponade balloons placement on a custom uterine atony model. Six blinded experts assessed video recordings using standardised criteria and the TeamSTEPPS Team Performance Observation Tool. The primary outcome was protocol adherence; secondary outcomes included procedure time and non-technical skill scores. RESULTS: All predetermined feasibility criteria were met (100% retention, 98% data completeness, κ=0.78 inter-rater reliability). Protocol adherence improved from 37.5% to 75% (absolute difference 37.5%, p = 0.075). Procedure completion time decreased from 10.8 ± 6.9 to 5.3 ± 1.5 min (p = 0.008, d = 1.1). Communication scores improved from 7.0 ± 4.6 to 11.4 ± 3.7 (p < 0.001, d = 1.05), leadership from 16.3 ± 6.0 to 19.7 ± 6.6 (p = 0.004, d = 0.54), and situation monitoring from 10.7 ± 8.3 to 16.3 ± 10.2 (p = 0.034, d = 0.61). The number needed to train to prevent one protocol deviation was 2.7. CONCLUSION: Paired-operator intrauterine tamponade balloons simulation with TeamSTEPPS integration proved feasible with promising preliminary efficacy. Effect sizes justify progression to a powered multicentre trial requiring 64 participants. These findings support mandatory competency-based assessment before clinical intrauterine tamponade balloons implementation.