Division of Maternal Fetal Medicine, Department of Obstetrics-Gynecology, and the Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and the Division of Maternal Fetal Medicine, Department of Obstetrics-Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Obstet Gynecol. 2015 Oct;126 Suppl 4:13S-20S. doi: 10.1097/AOG.0000000000001027.
To estimate whether simulation training improves medical students' cervical examination accuracy.
The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does not objectively assess trainee competence. To address these issues and optimize training, we assessed the effectiveness of cervical examination simulation in third-year medical students.
During the obstetrics and gynecology clerkship, a cohort study was performed in which third-year students were assigned to receive cervical examination simulation (n=50) or vaginal delivery simulation (n=48), with each group serving as a simulation-naive control for the other skill. As a final assessment, students performed 10 cervical examinations using task trainers. Exact accuracy and accuracy within 1 cm were compared between groups. Cumulative summation analyses were performed on the cervical examination group to assess competence and the average number of repetitions needed to achieve it.
Cervical examination students were significantly more accurate (Mann-Whitney, P<.001) in assessing dilation (73% exact, 98% within 1 cm) and effacement (83% and 100%) than vaginal delivery students (dilation 52% and 82%, effacement 51% and 96%). In the cumulative summation analyses, 65-100% of students attained competence during the clerkship depending on the level of accuracy and cervical parameter assessed. On average, competence was achieved with 27-44 repetitions.
Simulation training dramatically improved student accuracy in labor cervical examinations. Because not all students achieved competence, the cumulative summation analyses suggest that more than 100 repetitions would be needed if the goal was for the entire class of students to achieve competence.
II.
评估模拟训练是否能提高医学生的宫颈检查准确性。
分娩宫颈检查的培训模式会让患者接受额外的检查，缺乏金标准，并且无法客观评估学员的能力。为了解决这些问题并优化培训，我们评估了模拟宫颈检查在三年级医学生中的效果。
在妇产科实习期间，我们对三年级学生进行了一项队列研究，将他们分为接受宫颈检查模拟（n=50）或阴道分娩模拟（n=48）的两组，每组都是另一项技能的模拟对照组。作为最终评估，学生使用任务培训器进行了 10 次宫颈检查。比较了两组间的检查准确性和 1cm 内的准确性。对宫颈检查组进行了累积和分析，以评估能力和达到该能力所需的平均重复次数。
宫颈检查组在评估扩张度（73%的精确率，98%的 1cm 内精确率）和消蚀度（83%和 100%）方面明显更准确（Mann-Whitney，P<.001），而阴道分娩组为（扩张度 52%和 82%，消蚀度 51%和 96%）。在累积和分析中，根据评估的准确性和宫颈参数，65-100%的学生在实习期间达到了能力水平。平均而言，通过 27-44 次重复就可以达到能力。
模拟训练显著提高了学生在分娩宫颈检查中的准确性。由于并非所有学生都达到了能力水平，累积和分析表明，如果目标是让全班学生都达到能力水平，则需要进行超过 100 次重复。
II 级。
