Effectiveness of a Simulated Training Model for Procedural Skill Demonstration in Neonatal Circumcision

Abstract

Although existing evidence is insufficient to recommend routine neonatal male circumcision, it is a procedure commonly performed in the United States. There are no commercially available infant penile models available for circumcision training. We improved the design of a low-fidelity penile model constructed of cocktail wieners following the one by Brill and Wallace (Fam Med 2007;39:241-243) and attached it to a high-fidelity infant simulator. Providing simulated movement and crying similar to what is encountered in routine newborn circumcisions create a more realistic training scenario.The study objectives were to (1) evaluate the educational experience of a simulated skill training program as perceived by participants based on a comparison scale and (2) evaluate the fidelity of the simulated model. Standardized workshops were held for family medicine (n = 23) and obstetrics/gynecology (n = 6) residents (n = 29). Residents evaluated the realism of the simulation, the realistic adequacy of the model, and the overall educational effectiveness of the workshop. Using a Likert scale where 1 was the lowest and 4 was the highest, the average participant ratings were 3.96 for educational experience and improved medical knowledge and 3.89 for improved technical ability for both Mogen and Gomco clamps. The model was evaluated for anatomic landmarks (3.7), anesthesia administration (3.9), dorsal crush and slit (3.9), and breaking adhesions (3.5). Qualitative comments for perceived fidelity of the model were summarized. This project demonstrated successful development of a low-cost, easy-to-construct penile model combined with a high-fidelity infant simulator that, according to the responses of the participants in this study, enhances the simulated neonatal circumcision training. A tutorial for model construction and investigator-developed skill assessment checklists for Gomco and Mogen techniques are included in this technical report.