Accuracy of simulated cervical dilation and effacement measurements among practitioners

To determine whether hard or soft cervical models produced more accurate results when examined by practitioners of various experience levels.

Simulated hard and soft cervical models were placed in a chamber designed to simulate a realistic vaginal examination. These cervical dilation and effacement models ranged from 1 cm to 6 cm and from thick (4 cm) to complete (0.2 cm). Each examiner had 20 seconds to evaluate each of 12 models of varying dilation and effacement using the soft and then the hard models. Models of the same dilation and effacement were presented to each practitioner in the same sequence. Physicians, nurses, and residents did the cervical evaluations.

Of 360 recorded dilation measurements, only 19% were exactly correct using the soft models, whereas 54% were exact using the hard models. The percentages correct using hard cervix models progressively decreased with advancing cervical dilation. No consistent trend was found using the soft models. The respective results for correct effacement measurements were 49% soft versus 58% hard.

Assessment of cervical dilation and effacement was consistently more accurate in the hard, compared with the soft, cervical model. The greatest deviation between the models was noted among the residents, suggesting that beginning practitioners may benefit from learning on firm models before progressing to more realistic soft models. However, it should also be noted that all practitioners might benefit from practice with soft models, especially to determine accurate dilation because scores in this category were consistently below what might be expected.