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Retention of Vaginal Breech Delivery Skills Taught in Simulation

Published:August 15, 2017DOI:https://doi.org/10.1016/j.jogc.2017.06.029

      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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