Dayal Ashlesha K, Fisher Nelli, Magrane Diane, Goffman Dena, Bernstein Peter S, Katz Nadine T
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, USA.
Simul Healthc. 2009 Fall;4(3):155-9. doi: 10.1097/SIH.0b013e3181b3e4ab.
To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students' performance and confidence in vaginal delivery maneuvers with and without simulation training.
Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1-5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs.
Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 +/- 3.7 versus 6.2 +/- 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 +/- 0.83 versus 3.00 +/- 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 +/- 0.94 versus 2.07 +/- 1.22, respectively, P < 0.001) and week 5 (4.88 +/- 0.33 versus 4.31 +/- 0.63, P < 0.001) in the simulated environment.
Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.
确定阴道分娩操作模拟训练与临床实习期间后续参与实际分娩之间的关系，并评估医学生在接受和未接受模拟训练情况下进行阴道分娩操作的表现和信心。
在为期6周的临床实习开始时，将医学生随机分为接受或不接受在人体模型模拟器上进行阴道分娩操作模拟训练两组。两组均接受传统的理论和临床教学。一名对随机分组不知情的研究人员对学生在模拟器上的分娩操作能力和整体分娩表现进行评分。在实习的第1周和第5周对分娩表现进行评分（1 - 5分，5分为最高分）。在第1周和第5周对学生进行调查，以评估其进行分娩操作能力的自信心，并使用学生产科患者日志评估其参与实际分娩的情况。
33名学生被随机分组，18名接受模拟训练[模拟组（SIM）]，15名未接受模拟训练[对照组（CON）]。临床实习日志显示，模拟组学生参与的分娩次数多于对照组学生（9.8±3.7次对6.2±2.8次，P < 0.005）。与实习结束时的对照组相比，模拟组报告其进行阴道分娩的能力信心增强（分别为3.81±0.83对3.00±1.0，P < 0.05）。在模拟环境中，与对照组相比，模拟组在第1周（分别为3.94±0.94对2.07±1.22，P < 0.001）和第5周（4.88±0.33对4.31±0.63，P < 0.001）的整体分娩表现得分显著更高。
接受模拟训练的学生在临床实习期间在临床环境中的参与度更高。学生模拟训练有利于在低风险环境中学习产科技能，展示操作能力，并将这种能力转化为更高的临床参与度和信心。
