{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:05:05Z","timestamp":1789632305263,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2010based training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study analyzed pre\u2010 and post\u2010training 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2010training total scores improved overall, with a mean post\u2010training score of 8.4 out of 10. Larger percentage improvements were generally seen in cohorts with lower baseline scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standardized simulation\u2010based training for vaginal breech delivery was associated with short\u2010term improvements in simulated technical performance across diverse clinical and regional settings. Further work is needed to validate the assessment tool, assess long\u2010term skill retention, and determine whether simulation\u2010based performance gains translate into improved maternal and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71307","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:31:39Z","timestamp":1789630299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Closing the gap in breech delivery competence: A multi\u2010country analysis of simulation\u2010based training for breech births"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0711-662X","authenticated-orcid":false,"given":"Jagdeesh","family":"Kaur","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Department Sarawak General Hospital  Kuching Sarawak Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaneemalai","family":"Jeganathan","sequence":"additional","affiliation":[{"name":"Obstetrical and Gynaecological Society of Malaysia  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boon Nee","family":"Tang","sequence":"additional","affiliation":[{"name":"Obstetrical and Gynaecological Society of Malaysia  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunasegaran P. 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