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Effectiveness of Simulation Learning for Management of Breech Presentation

Background: In order to reduce the high rate of primary Cesarean sections in the United States, the American Congress of Obstetrics and Gynecology has suggested multiple measures physicians may utilize in the management of labor.  One of these recommendations is to increase the use of external cephalic version for managing breech presentations at term, and another suggests that vaginal breech delivery is a reasonable option for carefully selected patients. As these deliveries are rare, a simulation-based curriculum was designed for physicians to learn and practice skills in managing breech deliveries. 


Methods: A curriculum was designed using standardized patient consultations and skills workshops for 3 obstetrical skills modules. In the first module, learners counseled a standardized patient and performed an external cephalic version on a task-trainer. In the second module, learners counseled a patient for vaginal breech delivery who refuses Cesarean section.  In the third module, learners practiced a vaginal breech delivery and the use of Piper Forceps on a birthing manikin.   Thirteen obstetrics and gynecology residents from two academic institutions participated. Outcome measures were pre/post-knowledge tests, confidence-rating surveys and validated performance assessments. Scores were compared using statistical analysis. 


Results: All residents achieved competency by the end of the program based on performance assessments. Knowledge test score improvements were approaching significance (+9.03%, p=0.09). On a 5-point Likert scale, resident confidence levels showed significant improvement for each module with the greatest improvements in their confidence to use Piper’s forceps (+2.27, p=0.0001), perform a vaginal breech delivery (+1.78, p=0.0001), counsel a patient on her options for vaginal breech delivery (+1.5, p=0.0001), consent a patient for an external cephalic version (+0.64, p=0.0001) and perform an external cephalic version (+1.25, p=0.0018). 


Discussions: This simulation-based curriculum for the management of breech deliveries was effective at improving the knowledge, skills and attitudes of Obstetrics and Gynecology residents. This program offers tools for reducing the incidence of Cesarean sections due to breech presentation.


Keywords: Assessment, Curriculum Development/Evaluation, Evaluation of Clinical Performance, Instructional Materials/Methods, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Standardized Patient,

General Information

Resident,Faculty,Clerkship Director,Clerkship Coordinator,Osteopathic Faculty,Residency Director,Residency Coordinator,
Patient Care,Medical Knowledge,Interpersonal & Communication Skills,Practice-Based Learning & Improvement,
Assessment,Simulation,Standardized Patient,
Clinical Focus

Author Information

Audrey Bowes, MD, Carolinas Medical Center; Emily Marko, MD FACOG CHSE; Meghan Semiao, BS, CHSE

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