Abstract
Resuscitative hysterotomy is a daunting and rarely performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal opportunity for simulation-mediated deliberate practice. The authors propose a novel training program using a homegrown, realistic, simulation device as a means to practice resuscitative hysterotomy. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine (EM) residents. The simulated human placenta, bladder, amniotic sac, and uterus were constructed through the use of porcine skin, porcine stomach, transparent plastic bag, Foley tubing, and squid mantle, all secured with nylon sutures. A Gaumard S500 Articulating Newborn was inserted in the simulated uterus, and the entire model was placed into a Gaumard S500 Childbirth Simulator. Each model required less than 1 h for assembly. Emergent hysterotomy was first demonstrated by an EM faculty facilitator, followed by hands-on deliberate practice. Formal feedback on the learners’ self-reported confidence and satisfaction levels was solicited at the end of the workshop through a survey previously cited for use with a low-fidelity resuscitative hysterotomy. Quantitative evaluation of the simulated training session was extracted through a 5-item questionnaire using a 5-point Likert-type scale (i.e., from 1, strongly disagree, to 5, strongly agree). Item scores were added for a cumulative total score, with a possible maximum score of 25 and minimum score of 5. Responses were overwhelmingly positive [24.13 (± 1.36)]. Qualitative feedback was extracted from the survey through open-ended questions; these responses highlighted learners’ appreciation for hands-on practice and the development of a novel, tissue-based simulation task trainer. All participants recommended the training session be available to future learners. Resuscitative hysterotomy is a high-stakes, low-frequency procedure that demands provider practice and confidence. Our hybrid, tissue-based hysterotomy model represents a feasible opportunity for training. The model is cost conscious, easily reproducible, and portable and allows for ample deliberate practice.
Highlights
The perimortem cesarean section, rebranded in recent years as the “resuscitative hysterotomy,” is perhaps the most daunting and infrequently performed procedure by emergency physicians, necessitating the frequent review of indications, techniques, and pitfalls to ensure the best possible outcome for mother and baby
Most residents indicated the model was a good representation of human anatomy [4.63 (± 0.62)] and helped them become more familiar [4.94 (± 0.25)] and prepared [4.88 (± 0.34)] to perform resuscitative hysterotomy
Participants using the current study model gave overall more positive feedback than the model utilized by Sampson et al.; the small sample size (16 in present study and 9 for Sampson et al.) is insufficient to achieve the appropriate level of statistical power for comparison via Student’s t tests (Fig. 2)
Summary
The perimortem cesarean section, rebranded in recent years as the “resuscitative hysterotomy,” is perhaps the most daunting and infrequently performed procedure by emergency physicians, necessitating the frequent review of indications, techniques, and pitfalls to ensure the best possible outcome for mother and baby. To further augment the realism of this model, the authors chose to design a lifelike task trainer that provided learners with the realistic feel of organic tissue Through this program innovation, the authors sought to (1) enhance procedural training of resuscitative hysterotomies; (2) integrate a realistic simulation model for hands-on, rapid cycle deliberate practice (RCDP) with EM residents; and (3) compare the efficacy of our task trainer with similar hysterotomy models for resident learners. Through the use of a survey previously cited in the simulation literature [6], the authors aimed to measure the following: preference of instructional delivery with regard to hysterotomy training, appreciation for human anatomic representation, applicability to clinical practice, comfort with performing resuscitative hysterotomy, and familiarity with the procedure.
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