Easter Sarah Rae, Gardner Roxane, Barrett Jon, Robinson Julian N, Carusi Daniela
Division of Maternal-Fetal Medicine and the Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and the Division of Maternal-Fetal Medicine, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
Obstet Gynecol. 2016 Oct;128 Suppl 1:34S-39S. doi: 10.1097/AOG.0000000000001598.
To describe a simulation-based curriculum on twin vaginal delivery and evaluate its effects on trainee knowledge and comfort about twin vaginal birth.
Trainees participated in a three-part simulation consisting of a patient counseling session, a twin delivery scenario, and a breech extraction skills station. Consenting trainees completed a 21-item presimulation survey and a 22-item postsimulation survey assessing knowledge, experience, attitudes, and comfort surrounding twin vaginal birth. Presimulation and postsimulation results were compared using univariate analysis. Our primary outcomes were change in knowledge and comfort before and after the simulation.
Twenty-four obstetrics and gynecology residents consented to participation with 18 postsimulation surveys available for comparison (75%). Trainees estimated their participation in 445 twin deliveries (median 19, range 0-52) with only 20.4% of these as vaginal births. Participants reported a need for more didactic or simulated training on this topic (64% and 88%, respectively). Knowledge about twin delivery improved after the simulation (33.3% compared with 58.3% questions correct, P<.01). Before training, 33.3% of participants reported they would strongly counsel a patient to attempt vaginal birth instead of elective cesarean delivery for twins compared with 50% after training (P=.52). Personal comfort with performing a breech extraction of a nonvertex second twin improved from 5.5% to 66.7% after the simulation (P<.01).
Resident exposure to twin vaginal birth is infrequent and variable with a demonstrable need for more training. Our contemporary obstetric climate is prioritizing vaginal birth despite less frequent operative obstetric interventions. We describe a reproducible twin delivery simulation associated with a favorable effect on resident knowledge and comfort levels.
描述一个基于模拟的双胎阴道分娩课程，并评估其对学员关于双胎阴道分娩的知识及舒适度的影响。
学员参与一个由患者咨询环节、双胎分娩场景及臀位牵引技能站组成的三部分模拟。同意参与的学员完成一份包含21项内容的模拟前调查问卷以及一份包含22项内容的模拟后调查问卷，以评估关于双胎阴道分娩的知识、经验、态度及舒适度。使用单变量分析比较模拟前和模拟后的结果。我们的主要结局指标是模拟前后知识及舒适度的变化。
24名妇产科住院医师同意参与，有18份模拟后调查问卷可供比较（75%）。学员估计他们参与了445例双胎分娩（中位数为19例，范围为0 - 52例），其中只有20.4%为阴道分娩。参与者表示需要针对该主题进行更多的理论或模拟培训（分别为64%和88%）。模拟后关于双胎分娩的知识有所提高（正确回答问题的比例从33.3%提高到58.3%，P <.01）。培训前，33.3%的参与者表示他们会强烈建议患者尝试阴道分娩而非选择性剖宫产来分娩双胎，培训后这一比例为50%（P = 0.52）。模拟后对非头位第二胎儿进行臀位牵引的个人舒适度从5.5%提高到66.7%（P <.01）。
住院医师接触双胎阴道分娩的机会少且不固定，显然需要更多培训。尽管手术产科干预频率降低，但我们当前的产科环境仍优先考虑阴道分娩。我们描述了一种可重复的双胎分娩模拟，其对住院医师的知识和舒适度水平有积极影响。
