Impact of a Resident-as-Teachers Objective Structured Teaching Examination (OSTE) on Medical Student Vaginal Delivery Learning Outcomes

Abstract

BACKGROUND: One of the most common procedures learned by medical students on the OBGYN clerkship is normal vaginal delivery. Currently, students learn this procedure at the bedside, from residents who have had no formal instruction in optimal teaching methods. METHODS: A quasi-experimental time-sequential static group study. Obstetrics and Gynecology (OBGYN) residents were exposed to a RaT curriculum consisting of a didactic session, an OSTE using a standardized student and NOELLE birthing simulator. Third-year medical students on the 6-week OBGYN clerkship logged all vaginal delivery experiences during academic years preceding and following the RaT curriculum, recording their level of involvement in each of 16 procedural steps (Likert-type scale: 1=Observed; 2=Assisted; 3=Performed with assistance; 4=Performed without assistance). The level of involvement ratings for each procedural step, were compared pre and post RaT intervention, using the χ2 test. P<.05 was considered statistically significant. RESULTS: A total of 240 and 204 delivery experiences, were recorded by students pre and post the RaT curriculum, respectively. Following the curriculum, a significantly greater proportion of student delivery experiences occurred with chief residents (PGY-4) than prior to the curriculum (19.6% versus 4.6%, P<.01). Mean student level of involvement scores for setting up the delivery table, patient draping, postpartum hemorrhage preventive measures, and inspection of the cervix/vagina/perineum were significantly higher post-curriculum, as compared to pre (2.53 versus 2.02, P<.01; 2.15 versus 1.87, P<.01; 2.56 versus 2.36, P=.01; 2.25 versus 2.05, P<.01). DISCUSSION: A residents-as-teachers vaginal delivery OSTE may increase engagement of PGY-4 residents in student teaching and the level of student involvement in certain aspects of actual vaginal delivery experiences.