Utility of a Simulation-Based Mastery Learning Curriculum for Teaching Labor and Delivery Procedures

Mastering obstetric procedural skills is difficult. These skills require a tactile understanding of pelvic anatomy, must be performed in real time, and learners' performance cannot be visualized by coaches, making it difficult to obtain feedback. Simulation-based mastery learning (SBML), a competency-based approach in which learners acquire skills to predefined standards in an environment free of risks, is a potential solution to this dilemma. By incorporating SBML into obstetric procedural skills training, learners have the opportunity to safely develop highly competent skills before engaging in patient care.

This was a prospective cohort study evaluating the utility of the SBML (DELIVER SBML curriculum) in developing knowledge and comfort with the independent performance of obstetric procedural skills in graduate medical education learners.

All learners (n=11) completed the DELIVER SBML curriculum and were able to successfully perform membrane rupture, cervical exams, fetal scalp electrode (FSE) placement, and intrauterine pressure catheter (IUPC) placement. They underwent a written knowledge assessment of obstetric procedural skills. Pre-SBML curriculum, the median number of questions correct was 9/10 (90%) (interquartile range (IQR) 6 (60%), 10 (100%)). Post-SBML, the median number of questions correct was: 9/10 (90%), (IQR 8 (80%), 10 (100%)), and Wilcoxon signed-rank testing demonstrated no statistically significant difference (p=0.102). Using a 5-point Likert Scale, participants expressed their degree of agreement with the statement, "I feel comfortable independently performing obstetric procedural skills." Pre-SBML, median ranking was 1/5 (Strongly Disagree), (IQR 1, 2). Post-SBML, median was 4/5 (Agree) (IQR 4,5), with a statistically significant difference noted (p=0.014).  Discussion: Learners have varying degrees of knowledge and comfort regarding obstetric procedural skills. Following completion of the DELIVER SBML curriculum, learners had significantly improved perceived readiness for independence in performing obstetric procedural skills, although no significant differences were noted on scores of written knowledge assessments.