# Do they practise what we teach? A mixed-methods investigation into learning transfer of the maternity team approach in maternity emergencies

## TL;DR

This study examines whether a structured maternity emergency training approach is applied in real-life clinical settings and identifies factors influencing its use.

## Contribution

The study introduces a mixed-methods investigation into the transfer of simulation-based maternity team training into clinical practice.

## Key findings

- MTA was inconsistently applied in real emergencies, with structured recaps most used and role allocation least used.
- Leadership, team culture, and team composition were key factors influencing MTA adoption.
- Observations confirmed partial MTA application, especially in unfamiliar or large teams.

## Abstract

Simulation-based training is widely used to improve teamwork in maternity emergencies. However, evidence of learning transfer into clinical practice remains inconsistent. The Maternity Team Approach (MTA)—a structured framework comprising of leadership, role allocation, systematic assessment, and structured recaps—was introduced in a maternity emergency training program at a quaternary tertiary hospital in Australia. This study explored whether the MTA is applied during real-life maternity emergencies and barriers and enablers to its translation in clinical practice.

A mixed-methods design involving focus groups, interviews, and live clinical observations. Sixty-two maternity clinicians (midwives, obstetricians, and students) participated in eight focus groups and four interviews. Clinical observations of fifty-four live maternity emergencies were conducted by trained raters using an MTA compliance tool. Qualitative data were analysed thematically and triangulated with observational findings.

Participants reported that while the MTA was perceived as useful and beneficial for coordination, communication, and patient experience,however, its application in practice was inconsistent. Structured recaps were most used, while explicit role allocation was less frequently observed. Five key themes influenced MTA uptake: leadership, team culture, team composition, nature of the emergency, and practice norms. Observational data confirmed partial application of MTA elements in clinical settings, particularly in emergencies involving large, unfamiliar, or ad hoc teams.

Despite high perceived value of the MTA, learning transfer into clinical practice is variable and context dependent. Effective leadership, supportive culture, consistent team composition, and alignment between training and real-world conditions are critical enablers. To optimise transfer, maternity emergency training programs should incorporate contextually adaptive strategies and post-training support mechanisms.

The online version contains supplementary material available at 10.1186/s41077-026-00414-1.