ABSTRACT
Cervical cerclage is a experience demanding procedure and which is difficult for most of the residents and maternal fetal medicine fellows to have the first experience on real patients. In this study we presented an in-expensive and easy to build model for cervical cerclage training.
Subject(s)
Cerclage, Cervical/education , Computer-Assisted Instruction/instrumentation , Cerclage, Cervical/methods , Computer Simulation , Computer-Assisted Instruction/economics , Computer-Assisted Instruction/methods , Costs and Cost Analysis , Education, Medical/economics , Education, Medical/methods , Equipment Design , Female , Humans , PregnancyABSTRACT
Many fields of medicine now routinely employ simulation while educating all levels of medical trainees. Unfortunately, OB-GYN has been slow to incorporate these beneficial adjuncts to traditional medical education, but thankfully the use of simulation is now increasing. Maternal-Fetal medicine procedures such as amniocentesis, in-utero stent placement, chorionic villus sampling, percutaneous umbilical blood sampling, and cervical cerclage placements are an area where simulation has great potential benefit. Here we describe the currently available simulation models for these procedures and outline specific training curricula designed to aid trainees in obtaining procedural competency in each. Although initial experiences with these training models and the curricula centered around them have been positive, in many cases their use remains limited. Our hope is that this manuscript will encourage others to incorporate simulation into their training programs as we believe it will enhance medical training and improve patient safety.
Subject(s)
Clinical Competence/standards , Education, Medical, Continuing/standards , Obstetrics/education , Patient Simulation , Amniocentesis , Animals , Cerclage, Cervical/education , Chorionic Villi Sampling , Education, Medical, Continuing/trends , Evidence-Based Emergency Medicine/education , Female , Humans , Learning Curve , Models, Anatomic , Models, Animal , Pregnancy , Uterine Cervical Incompetence/surgeryABSTRACT
INTRODUCTION: Performance of cervical cerclage is a difficult procedure for learners with limited operative experience. We present a task trainer for cervical cerclage, which can facilitate learner training in a preclinical environment. METHODS: A simulated vagina is first fashioned out of polyvinyl chloride pipe material to allow an appropriately shaped pelvic structure. To simulate collapsible vaginal sidewalls, a foam covered with latex sheets is used to line the inside of the task trainer. A "cervix" is made by cutting cylinders approximately 2 in in diameter and 4 in in length in frozen cow muscle. After thawing, the cervical models are fastened to a semirigid foam disk with suture, which is used to secure the cervix inside the polyvinyl chloride pipe at the top of the simulated vagina. The full cervical cerclage task trainer is then secured in a holder to stabilize it in place. Placement of a cervical cerclage can then be practiced with standard vaginal cerclage instruments. RESULTS: Cervical cerclage can be practiced in a nonclinical environment using this model. Several aspects of the procedure can be modified including the amount of vaginal tissue, length and caliber of the vagina, and pubic arch angle. This model allows beginning learners sequential training of increasing difficulty. Faculty and trainees alike found the trainer to be useful and felt that it helped in the acquisition of the surgical skills needed for cerclage placement in a clinical setting. CONCLUSIONS: This low-cost task trainer can provide Maternal-fetal Medicine fellows and obstetric/gynecology residents the opportunity to practice cervical cerclage placement in a nonclinical environment. It may help physicians to obtain or maintain proficiency despite the relative low frequency of the procedure in modern obstetric practice.
