Purpose: To evaluate the impact of simulation training of operative
vaginal delivery (OVD) on learner technique, operator comfort, and
patient-centered outcomes.
Background: Obstetric simulation affords learners opportunities to
acquire and to refine clinical skills in a low-stress environment while
potentially improving patient outcomes. However, the effect of simulation
on OVD training is less clear.
Methods: A systematic research protocol was constructed a
priori for the conduct of the literature search, study selection, data
abstraction and data synthesis. Electronic databases were searched for
educational randomized trials and observational studies assessing OVD
simulation training for OBGYN residents. The educational domains of
knowledge, skills and attitudes were evaluated. The Medical Education
Research Study Quality Instrument (MERSQI) was used to assess study
quality. The review was prospectively registered with PROSPERO.
Results: The search strategy yielded 30,812 articles, with 7
articles eligible for analysis (2 cohort studies, 1 case-control study, 4
cross-sectional studies). No randomized trials were identified.
Studies demonstrated simulation to improve learners’ skill with forceps
placement and generated force during extraction. While forceps simulation
had no change in procedure failure rates, there were significant decreases in
rates of maternal lacerations, neonatal injury, and special-care nursery
admission. Only one study evaluated the effect of simulation on provider
comfort, demonstrating increased provider comfort with vacuum-assisted
delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating
low-to-moderate quality.
Discussions: The available evidence suggests improvement in technique,
comfort, and patient outcomes with OVD simulation, but additional studies are
required to further characterize such benefits for both forceps and vacuum.
Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,
Omar Young,
MD, Washington
University in St. Louis School of Medicine; Katherine Bligard, MD MA; Kim
Lipsey, MLS
