Comparison of 3 Dilation and Evacuation Technical Skills Models

Abstract

Editor's Note: The online version of this article contains a table comparing the 3 dilation and evacuation models and photographs of the models. IntroductionSimulation is becoming the cornerstone for teaching clinical technical skills.1,2 Although a number of obstetric and gynecologic training models exist, none has been described in the literature for second-trimester surgical abortion or dilation and evacuation (D&E). Because complications associated with D&E have been directly related to provider skill level, 3 preclinical training with an appropriate model may improve patient safety, decrease trainer and trainee anxiety, and reduce the number of cases needed to achieve competency.Models can be expensive and may not be available in low-resource settings where the provision of safe abortion services can be life-saving. An easily and inexpensively produced model for use in low-and high-resource settings would be a valuable tool. One low-fidelity model that has been widely adopted for first-trimester uterine aspiration training is the papaya model, 4 which was shown to improve confidence and knowledge base during a medical student workshop.5 Other simple models exist in family medicine, emergency medicine, and urology. [6][7][8][9][10][11] No low-fidelity model has been formally described or evaluated in the literature for second-trimester D&E training. A D&E procedure differs significantly from uterine aspiration because it involves mechanical skills beyond sensing uterine texture and a greater understanding of the contours of the uterus and fetal parts.At the time of this study, 3 standard, low-fidelity D&E models existed. All have been used with trainees, yet the models have not been formally evaluated by experts in the field. We surveyed experienced D&E providers to assess how realistic these models were in simulating a D&E procedure.12 Our goal was to create an ideal composite model, with the most realistic components from each model. Methods Setting and ParticipantsWe administered a cross-sectional survey to secondtrimester US-based abortion providers at 2 national AbstractBackground Simulation training may improve patient safety, decrease trainer and trainee anxiety, and reduce the number of cases needed for competency. Complications associated with dilation and evacuation (D&E) have been directly related to provider skill level, yet no low-fidelity model has been formally described or evaluated in the literature for second-trimester D&E training.

Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls

“…We also organized a D&E simulation for local physicians utilizing a low-cost, low-fidelity simulation model similar to those described by Baldwin and Chor ( 11 , 12 ). The model consists of a “uterus” made of a 36 oz plastic rice jar and a “cervix” made using foam can holders cut and glued to different cervical “dilations,” then covered with fabric.…”

Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum

“…To address this need, we created and assessed a high-fidelity simulation designed to improve OB/GYN residents’ knowledge, confidence, and competence performing a second-trimester D&E and managing postprocedural hemorrhage, the most common serious complication of D&E. Prior studies have described the use of both low-fidelity 14 and partial trainer simulation models 15 , 16 for second-trimester D&E training that focus on the uterine evacuation portion of the procedure and were found to improve resident technical skill. Additional D&E simulation resources are publicly available but have not yet been evaluated.…”