Abstract
Objective
The optimal frequency of conducting simulation training for high-acuity, low-frequency
events in obstetrics and gynaecology residency programs is unknown. This study evaluated
retention over time of vaginal breech delivery skills taught in simulation, by comparing
junior and senior residents. In addition, the residents' subjective comfort level
to perform this skill clinically was assessed.
Methods
This prospective cohort study included 22 obstetrics and gynaecology residents in
a Canadian residency training program. Digital recordings were completed for pre-training,
immediate post-training, and delayed (10–26 weeks later) post-training intervals of
a vaginal breech delivery simulation, with skill assessment by a blinded observer
using a binary checklist. Residents also completed questionnaires to assess their
subjective comfort level at each interval.
Results
Junior and senior residents had significant improvements in vaginal breech delivery
skills from the pre-training assessment to both the immediate post-training assessment
(junior, P < 0.001; senior, P < 0.001) and the delayed post-training assessment (P < 0.001 and P = 0.001, respectively). There was a significant decline in skills between the immediate
and delayed post-training sessions for junior and senior residents (P = 0.003 and P < 0.001, respectively). Both junior and senior residents gained more comfort immediately
after the training (P < 0.001 and P < 0.001, respectively), without a significant change between immediate post-training
and delayed post-training comfort levels (P = 0.19 and P = 0.11, respectively).
Conclusion
Residents retained vaginal breech delivery skills taught in simulation 10–26 weeks
later, although a decline in skills occurred over this time period. Comfort level
was positively affected and retained. These results will aid in determining the frequency
of simulation teaching for high-acuity, low-frequency events in a residency simulation
curriculum.
Résumé
Objectif
On ignore quelle est la fréquence optimale de répétition de la formation par simulation
sur les problèmes obstétricaux et gynécologiques graves, mais peu fréquents, dans
le cadre des programmes de résidence. Cette étude a comparé des résidents juniors
et seniors afin d'évaluer leur degré de rétention, au fil du temps, des compétences
acquises durant une simulation sur l'accouchement par le siège. Leur degré d'aisance
par rapport à la mise en pratique de ces compétences en contexte clinique a également
été évalué.
Méthodologie
Nous avons mené une étude de cohorte prospective portant sur 22 résidents canadiens
en obstétrique et gynécologie. Des enregistrements numériques ont été réalisés avant
et immédiatement après la formation sur l'accouchement par le siège, ainsi qu'après
un certain temps (de 10 à 26 semaines plus tard), et une évaluation des compétences
a été effectuée à l'insu avec une liste de vérification dichotomique. Les résidents
ont répondu à un questionnaire visant à évaluer leur degré d'aisance à chaque étape.
Résultats
Une amélioration significative des compétences des résidents a été observée, tant
chez les juniors que chez les seniors, entre les évaluations menées avant et immédiatement
après la formation (juniors, P < 0,001; seniors, P < 0,001) et entre celles menées avant et un certain temps après la formation (P < 0,001 et P = 0,001, respectivement). Une perte significative des compétences des résidents juniors
et seniors a été observée entre les deux évaluations suivant la formation (P = 0,003 et P < 0,001, respectivement). Le degré d'aisance des résidents juniors et seniors était
plus élevé immédiatement après la formation (P < 0,001 et P < 0,001, respectivement), et aucun changement significatif n'a été rapporté entre
les deux évaluations suivant la formation (P = 0,19 et P = 0,11, respectivement).
Conclusion
Dans une évaluation de 10 à 26 semaines après la simulation, les résidents ont maintenu
leurs compétences en accouchement par le siège, et ce, même si une perte a été observée
au fil du temps. Le degré d'aisance a augmenté après la formation, puis s'est maintenu
par la suite. Ces résultats aideront à déterminer à quelle fréquence les formations
par simulation sur les problèmes obstétricaux et gynécologiques graves, mais peu fréquents,
devraient avoir lieu dans le cadre des programmes de résidence.
Key Words
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Article info
Publication history
Published online: August 15, 2017
Accepted:
June 20,
2017
Received:
March 8,
2017
Footnotes
Competing interests: See Acknowledgements.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
