Optimizing the amount of simulation training used to teach vaginal delivery skills to medical students

Abstract

Objective: To determine the amount of simulation training required for students to attain minimal competence and mastery of a vaginal delivery.Methods: An observational study was conducted at a US medical school between May 11, 2015, and May 8, 2016. Using a modified Angoff method, 10 members of the Obstetrics and Gynecology faculty evaluated a vaginal delivery procedural checklist and established cutoff scores for minimal competence and mastery. During a 5-week period, all third-year students received between two and five 45-minute vaginal delivery simulation sessions; performance was assessed during week 6. Performance according to the checklist was compared. Results:The cutoff score was 20 and 26 out of 30 for minimal competence and mastery, respectively. Among 115 students, mean checklist scores in final assessment rose with increasing number of simulations: 23.6, 25.1, 27.5, and 27.6 points for two, three, four, and five training sessions, respectively (P<0.001). The proportion of patients achieving mastery also increased with number of simulations: 34%, 59%, 73%, and 93% for two, three, four, and five training sessions, respectively (P<0.001). Two or three training sessions were sufficient to attain minimal competence in most students; however, no significant between-group difference was found. Conclusion:Simulation training exerts an increasing effect on performance with each additional session that students receive.

Application of medical simulation in the education of medical students in the area of gynecology and obstetrics

“…Other authors specify that already two or three 45-minutes sessions during which each student had the opportunity to receive delivery twice in a session was adequate to obtain minimum competence 6 months after the training. As a result of this form of education, it is also possible to learn more effectively how to deal with shoulder distortion or the management of postpartum haemorrhage [27][28][29].…”

Eficiencia del entrenamiento simulado del parto vaginal en estudiantes de enfermería/obstetricia

“…Este mismo grupo definió un segundo nivel de aprendizaje denominado maestría, para el cual al menos cinco sesiones fueron necesarias para lograr que el 93% de los alumnos alcanzara este nivel de dominio (Nitsche et al, 2018). El nivel de maestría fue definido por este grupo como el cumplimiento del 87% del máximo puntaje en la pauta de cotejo.…”

“…Pauta de cotejo y evaluación ciega: La pauta de cotejo fue diseñada con 37 procesos; 31 pertenecen al área motora y 6 al área actitudinal. Esta pauta fue elaborada por los docentes de la asignatura con base a una adaptación de tres instrumentos publicados sobre simulación en parto vaginal (Jude et al, 2006;Dayal et al, 2009;Nitsche et al, 2018). Se creó una lista de 40 procesos, y se pidió a un grupo de 5 profesores de medicina y enfermería/ obstetricia que seleccionaran aquellos indispensables de evaluar en los estudiantes, resultando en los 37 ítems contenido en la pauta de cotejo final (tabla 1).…”

“…Si bien hay investigación que ha demostrado la eficiencia de la simulación en lograr competencias clínicas, existen solo cinco estudios publicados que establecen la eficacia de la simulación en adquirir las destrezas necesarias para atender un parto vaginal (Shumard et al, 2016). Una investigación en estudiantes de medicina informó que luego de 4 o 5 partos atendidos en el simulador, comparado con 2 o 3, mejora significativamente el rendimiento de los alumnos en el puntaje obtenido en la pauta de cotejo para dicha práctica clínica, concluyendo que todos los estudiantes alcanzaban la mínima competencia luego de 4 partos simulados (Nitsche et al, 2018). Sin embargo, esta experiencia no ha sido evaluada en estudiantes de enfermería/obstetricia.…”

A Novel Application of the Modified Angoff Method to Rate Case Difficulty in Simulation-Based Research

“…Most applications of Angoff or similar methods have been used for procedural-based simulation, such as to determine competency in laparoscopy and set performance standards for airway management in emergency medicine (EM) residents. [14][15][16][17][18][19][20][21] In these studies, the experts are often establishing cutoff scores for minimal competence and mastery-based learning on a procedural checklist, where the experts can determine between pass and fail for each item on a cumulative score. Our application is intended to guide development for medical cases for resident physicians across a range of training levels.…”