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

Area of Science:

• Medical Education
• Surgical Simulation
• Obstetrics and Gynecology

Background:

• Limited training opportunities exist for second-trimester dilation and evacuation (D&E) procedures, hindering the development of essential skills among OB/GYN residents.
• Barriers such as restrictive laws, lack of faculty, and insufficient procedural volume impede traditional D&E training.
• Simulation-based training offers a viable solution to enhance clinical competency in this critical area of women's healthcare.

Observation:

• A high-fidelity simulation was developed for OB/GYN residents focusing on a second-trimester D&E for fetal demise and managing postprocedural hemorrhage.
• The simulation involved a multidisciplinary team including anesthesiology, nursing, and OB/GYN faculty, utilizing a mannequin-based approach.
• Learner performance was evaluated through pre/post-assessments, a critical action checklist, and facilitator focus groups.

Findings:

• Forty-nine residents participated over eight years, demonstrating improved competency in D&E procedures and increased confidence in managing hemorrhage post-simulation.
• Focus groups indicated that most learners exhibited confidence and effective team communication during decision-making roles within the simulation.
• The simulation effectively enhanced both technical skills and non-technical skills, such as teamwork and communication.

Implications:

• Simulation-based D&E training is crucial for improving resident skills and confidence in managing second-trimester abortions.
• This method provides a standardized platform for assessing learner performance and practicing high-acuity team-based care.
• Implementing such simulations can help overcome training barriers and ensure a competent workforce for essential reproductive health procedures.