Effectiveness of Vaginal Delivery Simulation in Novice Trainees.

OBJECTIVE: Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students. METHODS: During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill. As a final assessment of their skill, students performed a simulated vaginal delivery scored by a blinded observer using a procedural checklist (score 0-30). A satisfactory score was considered 26 or greater. The individual scores and percentage of satisfactory scores were compared between both groups using a Mann-Whitney U test and chi-square test, respectively. RESULTS: Vaginal delivery students had a significantly higher mean score (27 +/- 3.2) and percentage of students achieving a passing score (85%) than the cervical exam students (22 +/- 3.5 and 15%). There were no differences in vaginal delivery performance based on gender, nor was there any difference in the number of real-life deliveries performed between vaginal delivery and cervical exam students. CONCLUSIONS: Even though medical students had an equivalent clinical rotation experience, a short period of simulation training had a marked effect on their end-of-rotation performance. During initial resident or midwife training more than 5 hours of simulation will likely be required to properly prepare 100% of trainees.

Effectiveness of Labor Cervical Examination Simulation in Medical Student Education.

OBJECTIVE: To estimate whether simulation training improves medical students' cervical examination accuracy. BACKGROUND: The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does not objectively assess trainee competence. To address these issues and optimize training, we assessed the effectiveness of cervical examination simulation in third-year medical students. METHODS: During the obstetrics and gynecology clerkship, a cohort study was performed in which third-year students were assigned to receive cervical examination simulation (n=50) or vaginal delivery simulation (n=48), with each group serving as a simulation-naive control for the other skill. As a final assessment, students performed 10 cervical examinations using task trainers. Exact accuracy and accuracy within 1 cm were compared between groups. Cumulative summation analyses were performed on the cervical examination group to assess competence and the average number of repetitions needed to achieve it. RESULTS: Cervical examination students were significantly more accurate (Mann-Whitney, P<.001) in assessing dilation (73% exact, 98% within 1 cm) and effacement (83% and 100%) than vaginal delivery students (dilation 52% and 82%, effacement 51% and 96%). In the cumulative summation analyses, 65-100% of students attained competence during the clerkship depending on the level of accuracy and cervical parameter assessed. On average, competence was achieved with 27-44 repetitions. CONCLUSION: Simulation training dramatically improved student accuracy in labor cervical examinations. Because not all students achieved competence, the cumulative summation analyses suggest that more than 100 repetitions would be needed if the goal was for the entire class of students to achieve competence. LEVEL OF EVIDENCE: II.