59: The merit of simulation in teaching medical interns vaginal examination on laboring women

Abstract

To assess the added value of incorporating simulation in vaginal examination (VE) training on laboring women for medical interns The study was randomized controlled trial conducted in a single University Hospital. On the first day of their clinical rotation in our department, all the medical interns, having no previous vaginal examination’s experience, were given a 60 minutes-standardized course summarizing how to perform VE. At the end of the initial training course, they were randomly assigned to perform 10 VE training procedures using a simulator and a control group of interns with no performed any simulated VE. Then, both groups were asked to perform 10 VEs on laboring women in the delivery unit. They were asked to report the findings of 7 VE’s items (cervical dilation, cervical effacement, cervical position, fetal presentation, molding, position and station). The interns' findings were then compared with those of experienced obstetric specialists (whose findings were considered to be the gold standard) who examined the same women. Neither the specialists nor the patients were aware by which simulation group the interns belonged to. The primary outcome was the improvement of VE accuracy after practical training on VE simulators In total, 134 interns were successful in completing all the required examinations and included in the final analysis. Interns who had performed 10 simulated VEs showed significantly greater accuracy in VE assessments in comparison with the control group (p<0.0001). Interns who performed simulated VEs were significantly more successful in evaluating cervical dilatation (p= 0.002). The mean error in dilatation assessment was 0.77 ± 0.56 vs.1.62 ± 0.73 cm in simulation vs non-simulation groups respectively, p=0.0001). Additionally, the success rate in identification of cervical effacement was (84.8% vs. 58.8%, p=0.001), cervical position (80.3% vs. 64.7%, p=0.002), fetal presentation (90.9% vs. 77.9%, p=0.04), skull molding (84.8% vs. 63.2%, p=0.001), fetal position (78.8% vs. 61.7%, p=0.01), and finally station of the head (80.3% vs. 58.8%, p=0.001) in simulation versus non-simulation groups respectively. Simulation training for medical interns significantly improved their VE skills before practicing this maneuvers on laboring women. VE simulations should be included in the training course of interns before receiving their medical license.