Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2019; 09(01): e6-e9
DOI: 10.1055/s-0039-1677736
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Simulation to Improve Trainee Skill and Comfort with Forceps-Assisted Vaginal Deliveries

Kelsey Rose
1   Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
,
Kirsten Jensen
1   Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
,
Rong Guo
2   Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
,
Yalda Afshar 
1   Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
› Author Affiliations
Further Information

Publication History

12 November 2018

29 November 2018

Publication Date:
21 January 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Objective Simulation training is a powerful learning tool for low frequency events. Forceps-assisted vaginal deliveries (FAVD) are an important tool in reducing cesarean deliveries. The aim of this study is to create a high-fidelity simulation-based curriculum for residency education and investigate pre- and posttest skill and confidence.

Methods A prospective cohort study was conducted involving obstetrics and gynecology residents over 2 academic years. Residents participated in one to three FAVD simulation trainings. All sessions involved video, didactic, and hands-on practice. Pre- and postsurvey and skills assessment were conducted to assess confidence, ability to consent, and perform a FAVD. Wilcoxon's signed-rank tests and Kruskal–Wallis tests were used.

Results Thirty residents (73%) completed at least one forceps simulation training session. Participants demonstrated significant improvement in confidence (p < 0.005) following training. Before the intervention, there was a disparity in confidence by postgraduate level (p < 0.005); however, this difference was not seen postsimulation (p = 0.24). Residents demonstrated significant improvement in their FAVD skills (p < 0.05), as well as their ability to consent (p < 0.01).

Conclusion Simulation training improves residents' perceived confidence in FAVD. Simulation helped to better equalize confidence across classes. FAVD simulations improves resident confidence, skill, and more broadly broadened the armamentarium to decrease the cesarean delivery rate.

Keywords

forceps-assisted vaginal delivery - obstetrics - simulation - medical education - operative delivery

Note

There are no financial disclosures.


Supplementary Material

 

  • References

  • 1 Satin AJ. Simulation in obstetrics. Obstet Gynecol 2018; 132 (01) 199-209
    CrossrefPubMedGoogle Scholar
  • 2 Page RL. Brief history of flight simulation. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.132.5428&rep=rep1&type=pdf Accessed December 27, 2018
    PubMedGoogle Scholar
  • 3 Gardner R, Raemer DB. Simulation in obstetrics and gynecology. Obstet Gynecol Clin North Am 2008; 35 (01) 97-127 , ix
    CrossrefPubMedGoogle Scholar
  • 4 McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-base medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011; 86 (06) 706-711
    CrossrefPubMedGoogle Scholar
  • 5 Jude DC, Gilbert GG, Magrane D. Simulation training in the obstetrics and gynecology clerkship. Am J Obstet Gynecol 2006; 195 (05) 1489-1492
    CrossrefPubMedGoogle Scholar
  • 6 Nielsen PE, Goldman MB, Mann S. , et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol 2007; 109 (01) 48-55
    CrossrefPubMedGoogle Scholar
  • 7 Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116 (08) 1028-1032
    CrossrefPubMedGoogle Scholar
  • 8 Easter SR, Gardner R, Barrett J, Robinson JN, Carusi D. Simulation to improve training knowledge and comfort about twin vaginal birth. Obstet Gynecol 2016; 128 (Suppl. 01) 34S-39S
    CrossrefPubMedGoogle Scholar
  • 9 Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1
    PubMedGoogle Scholar
  • 10 American College of Obstetricians and Gynecologists; Society of Maternal-Fetal Medicine, Caughey; Caughey AB, Cahill AG, Guise J-M, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 123: 693-711
    CrossrefPubMedGoogle Scholar
  • 11 Shaffer BL, Caughey AB. Forceps delivery: potential benefits and a call for continued training. J Perinatol 2007; 27 (06) 327-328
    CrossrefPubMedGoogle Scholar
  • 12 Gupta N, Dragovic K, Trester R, Blankstein J. The changing scenario of obstetric and gynecology residency training. J Grad Med Educ 2015; 7 (03) 401-406
    CrossrefPubMedGoogle Scholar
  • 13 Dildy GA, Belfort MA, Clark SL. Obstetric forceps: a species on the brink of extinction. Obstet Gynecol 2016; 128 (03) 436-439
    CrossrefPubMedGoogle Scholar
  • 14 Gossett DR, Gilchrist-Scott D, Wayne DB, Gerber SE. Simulation training for forceps-assisted vaginal delivery and rates of maternal perineal trauma. Obstet Gynecol 2016; 128 (03) 429-435
    CrossrefPubMedGoogle Scholar