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The aim of this before and after study was to evaluate the efficacy of a complex operative obstetrics course in improving practitioner confidence. The course covered rotational instrumental vaginal delivery, vaginal breech delivery, cervical cerclage, management of postpartum haemorrhage, and complex caesarean section. Participants filled in a pre- and postcourse questionnaire using a Likert scale to rate confidence from 1 (not confident) to 5 (very confident) in 15 key skills. Data were analysed using a two-sample  t -test for comparison of means. Data were collected from 67 participants. Practitioner confidence increased across all skills studied. The largest increases in mean confidence scores were seen in classical caesarean section (score increase 2.45;  p  &lt; 0.05) and management of head entrapment at breech (score increase 2.24;  p  &lt; 0.05). The course was successful in improving practitioner confidence across a range of obstetric skills.Impact statementWhat is already known on this subject?  Team-based training for obstetric emergencies has been shown to improve practitioner knowledge, team behaviours and patient outcomes. Simulation training in operative vaginal delivery improves operator technique and reduces adverse outcomes for mothers and babies.What do the results of this study add?    Hands-on simulator training in complex operative obstetrics improves practitioner confidence in managing a range of obstetric emergencies including those less frequently encountered. These include rotational instrumental delivery, vaginal breech delivery, complex caesarean section, postpartum haemorrhage and cervical cerclage.What are the implications of these findings for clinical practice and/or future research?  This study supports the increased use of simulation in advanced obstetric training with an easily replicated cost efficient course. Further research is warranted to determine whether simulation training improves practitioner competence and patient outcomes. What is already known on this subject?  Team-based training for obstetric emergencies has been shown to improve practitioner knowledge, team behaviours and patient outcomes. Simulation training in operative vaginal delivery improves operator technique and reduces adverse outcomes for mothers and babies. What do the results of this study add?    Hands-on simulator training in complex operative obstetrics improves practitioner confidence in managing a range of obstetric emergencies including those less frequently encountered. These include rotational instrumental delivery, vaginal breech delivery, complex caesarean section, postpartum haemorrhage and cervical cerclage. What are the implications of these findings for clinical practice and/or future research?  This study supports the increased use of simulation in advanced obstetric training with an easily replicated cost efficient course. Further research is warranted to determine whether simulation training improves practitioner competence and patient outcomes.

A before and after study of the impact of simulation training on practitioner confidence in complex operative deliveries