Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
Obstet Gynecol. 2012 Oct;120(4):809-14. doi: 10.1097/AOG.0b013e31826af9a9.
To compare the skills of performing a shoulder dystocia management algorithm after hands-on training compared with demonstration.
We randomized medical students to a 30-minute hands-on (group 1) and a 30-minute demonstration (group 2) training session teaching a standardized shoulder dystocia management scheme on a pelvic training model. Participants were tested with a 22-item Objective Structured Assessment of Technical Skills scoring system after training and 72 hours thereafter. Objective Structured Assessment of Technical Skills scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were the secondary outcomes. Statistics were performed using Mann-Whitney U test, χ test, and multiple linear regression analysis.
Two hundred three participants were randomized. Objective Structured Assessment of Technical Skills scores were significantly higher in group 1 (n=103) compared with group 2 (n=100) (17.95±3.14 compared with 15.67±3.18, respectively; P<.001). The secondary outcomes global rating scale (GRS; 10.94±2.71 compared with 8.57±2.61, respectively; P<.001), self-assessment (3.15±0.94 compared with 2.72±1.01; P=.002), and confidence (3.72±0.98 compared with 3.34±0.90, respectively; P=.005), but not performance time (3:19±0:48 minutes compared with 3:31±1:05 minutes; P=.1), were also significantly different, favoring group 1. After 72 hours, Objective Structured Assessment of Technical Skills scores were still significantly higher in group 1 (n=67) compared with group 2 (n=60) (18.17±2.76 compared with 14.98±3.03, respectively; P<.001) as were GRS (10.80±2.62 compared with 8.15±2.59; P<.001) and self assessment (SA; 3.44±0.87 compared with 2.95±0.94; P=.003). In a multiple linear regression analysis, group assignment (group 1 compared with 2; P<.001) and sex (P=.002) independently influenced Objective Structured Assessment of Technical Skills scores.
Hands-on training helps to achieve a significant improvement of shoulder dystocia management on a pelvic training model.
www.ClinicalTrials.gov, NCT01618565.
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比较实操培训与演示培训后行肩难产管理算法的技能。
我们将医学生随机分为 30 分钟实操（第 1 组）和 30 分钟演示（第 2 组）培训，在骨盆训练模型上教授标准化肩难产管理方案。培训后及 72 小时后，参与者使用 22 项客观结构化临床技能评估（OSCE）评分系统进行测试。OSCE 评分是主要结局。次要结局包括操作时间、自我评估、信心和总体评估量表。统计分析采用曼-惠特尼 U 检验、卡方检验和多元线性回归分析。
共纳入 203 名参与者。第 1 组（n=103）的 OSCE 评分明显高于第 2 组（n=100）（17.95±3.14 比 15.67±3.18，P＜0.001）。次要结局总体评估量表（GRS；10.94±2.71 比 8.57±2.61，P＜0.001）、自我评估（3.15±0.94 比 2.72±1.01，P=0.002）和信心（3.72±0.98 比 3.34±0.90，P=0.005）也有显著差异，第 1 组更佳，但操作时间（3:19±0:48 分钟比 3:31±1:05 分钟，P=0.1）无显著差异。72 小时后，第 1 组（n=67）的 OSCE 评分仍明显高于第 2 组（n=60）（18.17±2.76 比 14.98±3.03，P＜0.001），GRS（10.80±2.62 比 8.15±2.59，P＜0.001）和自我评估（SA；3.44±0.87 比 2.95±0.94，P=0.003）也有显著差异。多元线性回归分析显示，组间分配（第 1 组比第 2 组，P＜0.001）和性别（P=0.002）独立影响 OSCE 评分。
实操培训有助于在骨盆训练模型上显著提高肩难产管理能力。
www.ClinicalTrials.gov，NCT01618565。
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