See related article by Varghese.
We read with interest the paper by Varghese et al.1 regarding the limited effectiveness of a skills and drills intervention to improve emergency obstetric and newborn care and the accompanying editorial by Ricca.2
Ricca discussed some possible reasons as to why the intervention had limited effect when it came to improved diagnosis and management of maternal and newborn complications, including systems weaknesses, provider motivation and behavior, and barriers to teamwork in the workplace.
We would like to draw attention to a further possible reason for the limited effectiveness in translating the training into demonstrable improvements in …