A randomized trial of clustered vs spaced simulation in forceps-assisted vaginal deliveries
Andrew T Greene1, Matthew Zuber1, Joshua Nitsche1
1Wake Forest University School of Medicine, Winston-Salem, NC (Greene, Zuber, Nitsche, and Newman).
Background:
The rates of forceps-assisted vaginal deliveries in the management of the second stage of labor are decreasing. This decline is mirrored by fewer learning opportunities for resident trainees in obstetrics. Previous studies have demonstrated an increase in the skill and confidence of trainees in performing forceps-assisted vaginal delivery with simulation. The optimum timing and frequency of simulation sessions to improve skill retention are currently unknown.
Objective:
This study aimed to test the effects of clustered vs spaced training sessions to teach trainees forceps-assisted vaginal delivery to determine whether spaced training sessions would lead to superior retention of skill. A commercially available pelvic trainer (Lucy's Mum; MODEL-med International, Cheltenham, Australia) was used, and Objective Structured Assessment of Technical Skills scores were measured at >1 month after the intervention.
Study Design:
This was a randomized controlled trial of clustered vs spaced forceps-assisted vaginal delivery simulation sessions. This study included 35 participants, giving 80% power to detect a difference in the Objective Structured Assessment of Technical Skills score of 6. Trainees and obstetrical providers who did not independently perform forceps-assisted vaginal delivery were randomized in blocks to a single learning session (clustered: 30 minutes of hands-on teaching with a model [n=17]) or 3 individual learning sessions (spaced: 10 minutes each [n=18]) spaced 1 week apart. Participants completed an online module introducing forceps-assisted vaginal delivery and completed skillset questionnaires before and after the simulation. A chest-mounted GoPro camera (GoPro, Inc, San Mateo, CA) was used to capture the first-person point-of-view technique to blind expert adjudicators to the participants' identities. Blinded footage was used to grade the average Objective Structured Assessment of Technical Skills scores.
Results:
Both clustered and spaced simulation training led to improved forceps-assisted vaginal delivery Objective Structured Assessment of Technical Skills scores after the intervention (+4.8 vs +5.9, respectively, from baseline). However, the median change was not different between randomization groups (Wilcoxon rank-sum test, P=.78). Both simulation groups had higher confidence to apply forceps, perform safety checks, and independently/safely perform forceps-assisted vaginal delivery (t test, P<.05).
Conclusion:
This study described the novel use of a point-of-care video and simulator application to improve forceps-assisted vaginal delivery simulation training. Objective Structured Assessment of Technical Skills scores and provider self-assessment of training improved, regardless of clustered vs spaced simulation sessions. El resumen está disponible en Español al final del artículo.
