Purpose: To improve resident “readiness” for clinical training
opportunities in forceps delivery.
Background: Exposure to forceps-assisted delivery is declining
nationwide. In the clinical learning environment, forceps training
opportunities are often acute/emergent. Simulation training may help residents
feel more prepared for such opportunities.
Methods: Eleven residents (PGY1-4) underwent 8 hours training
on forceps delivery over 6 months. The curriculum included a 2-hour didactic
session (covering case selection, clinical evaluation, safety checks and global
second stage awareness) followed by three 2-hour simulation training sessions
utilizing “Lucy and Lucy’s Mum” (MODEL-med, Australia) at 3-monthly intervals.
Knowledge/confidence scores (10-point VAS) were assessed at baseline and 3/6
months later. A 20-point skills checklist was used to objectively score
residents’ procedural competency before each simulation session as well as 2
weeks after the first.
Results: Knowledge scores increased from 53±5.4% pre-training
to 64±5.3% at 3 months and 77±6.8% at 6 months (p=0.007). Confidence scores
increased from 22±8.3% pre-training to 33±9.2% at 3 months and 49±9.6% at 6
months (p=0.046). Skills assessment scores were 47±7.2% at baseline and
increased to 76±5.0% two weeks after the first simulation (p< 0.01). Scores
remained higher at 3 months (79±2.3%, p< 0.001) and 6 months (93±0.9%, p<
0.001). Pre-training there was an effect of seniority (p=0.002) with lowest
scores for PGY1 (12±0.9%) and highest for PGY4 (59±9.3%). Post-training scores
were independent of PGY level (p=0.605).
Discussions: Structured simulation training increases residence
knowledge, skills and confidence levels with respect to forceps delivery and
may help supplement clinical learning opportunities to protect against loss of
this valuable skill.
Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Quality & Safety,
David Carr,
MD, PhD; University of Vermont; Erin Morris,
MD
