Novel Simulation Workshop Improves Performance in Vacuum Delivery

Abstract

Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p < 0.001) in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.

Perceptions of Trainees About Use of Simulation in Gynaecology and Obstetrics

“…Results vindicate the importance of simulation to improve clinical skills and experience at both behavioural and technical levels in OB/GYN units. 10 like procedural simulations for forceps-assisted delivery, 11 correct vacuum cup placement, 12 shoulder dystocia management, 13 and salpingectomy for ectopic pregnancy, 14 as well as at behavioural level confidence and professional behaviour with the patient also improvement. 15 A survey among OB/GYN trainees and fellows showed 80% responses regarding the improvement in surgical skills due to simulation and then the transfer of those skills at the real-life operating theatre.…”

Comparison of a practice-based versus theory-based training program for conducting vacuum-assisted deliveries: a randomized-controlled trial

“…One study including 36 participants reported that a simulation-based training program for VAD resulted in a significant improvement in the accuracy of cup application and theoretical knowledge [ 28 ]. Unfortunately, no validated global or procedure-specific skill rating scale was used and no long-term follow-up was performed.…”

An engineering perspective of vacuum assisted delivery devices in obstetrics: A review

“…There have been considerable efforts to improve the proficiency of obstetric trainees through simulation-based workshops focussed on cup placement and the theory of vacuum delivery. 96 However, there remains a lack of knowledge to inform best practice, in particular understanding what constitutes safe application of a vacuum (in terms of rate, magnitude and time) and tractive force (in terms of magnitude and rate). For instance, increasing vacuum rate may reduce the time required to perform a delivery but bring increased maternal distress and foetal trauma; mechanical interactions between these phenomena are important but less well researched than some of the clinical factors and subsequent complications.…”