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Simulated vaginal delivery training 'effective' tool

Medical students who received simulated training for vaginal delivery were better prepared for performing real-life vaginal deliveries, compared with students who received simulated cervical exam training, according to research published in Family Medicine.  

“As residency programs strive to provide adequate obstetrical training amidst the ongoing decline in clinical training opportunities for vaginal deliveries, it is essential that all trainees be properly prepared for their initial real-life deliveries,” Kristina M. Shumard, MD, of the department of obstetrics/gynecology, Wake Forest School of Medicine, and colleagues wrote. “However, the amount of training received was not sufficient for all trainees to achieve a satisfactory score. This suggests that not only is vaginal delivery simulation an effective form of training, but a significant amount of time needs to be set aside if simulation is to properly prepare 100% of residents and midwifery students for their initial clinical responsibilities on [labor and delivery].”

For this study, 110 third-year medical students were taught the principles of vaginal delivery and labor cervical exam for a week, then received hands-on experience in both procedures. From there, 54 students continued simulation training in vaginal deliveries, and the remaining 56 students — simulation-naive controls for the vaginal delivery group — concentrated on labor cervical exam simulation training. After week 5, each student was scored on a simulated vaginal delivery performance.

According to researchers, the vaginal delivery group scored higher on overall smoothness of delivery and supporting the infant after delivery before corrections for multiple comparisons were made. After those corrections, their scores were significantly higher in patient conversations and for evaluating nuchal cord, fetal position and fetal station. Their total checklist scores and the percentage of students achieving satisfactory scores were also higher than the cervical exam group. Only 15% of the cervical exam group received satisfactory scores, vs. 85% of the vaginal delivery group.

Scores on delivery of placenta, body and anterior shoulder, as well as supporting the perineum and controlling the head’s delivery, were not significantly different between the groups, indicating that students receive enough exposure to these tasks while on labor and delivery training, according to the researchers. In addition, the number of real-life deliveries performed was similar, regardless of group.

The researchers wrote that though medical students receive help with vaginal deliveries upon finishing their obstetrics/gynecology clerkship, these students are expected to complete steps considered imperative to mother and child’s safety.

“Based on our findings, simulation appears to be an effective way to provide such preparation, allowing trainees to take full advantage of their initial real-life deliveries by lessening their anxiety and imparting many of the fundamental skills required to execute a safe vaginal delivery,” Shumard and colleagues wrote. – by Janel Miller

Disclosure: Healio.com/Family Medicine was unable to determine researchers’ relevant financial disclosures prior to publication.