Statistical analysis
First, the inter-group comparisons were analysed to confirm the validity of the simulation-based training at Kirkpatrick level 3. Second, the relationship between programme attendance and massive transfusion was analysed to confirm the validity of the programme at Kirkpatrick level 4. Receiver operating characteristic (ROC) curve analysis of massive blood transfusion and the amount of blood loss at the referring hospitals was performed to determine the cut-off level of massive blood transfusion and to analyse the relationship between massive blood transfusion and programme attendance. Inter-group comparisons were performed using the Student t-test and nonparametric test for continuous variables (maternal age, body mass index at delivery, parity, SI, amount of blood loss, time from delivery to maternal transfer, body temperature, and Hb level on arrival) or the Fisher’s exact test for nominal variables (mode of conception, mode of delivery, oxygen administration, existence of an SI record, use of more than two IV routes with lines ≥20 gauge, unconsciousness, massive transfusion, hysterectomy, IVR use, and maternal death). Relationships between massive blood transfusion and other variables were analysed using logistic regression analysis. A p-value of <0.05 was considered statistically significant. All statistical analyses were performed using EZR (version 1.54, Saitama Medical Center).22