Bartz Deborah, Paris Amy, Maurer Rie, Gardner Roxane, Johnson Natasha
Brigham and Women's Hospital, 1620 Tremont St, OBC-3, Boston, MA 02120 USA.
Harvard Medical School, Boston, MA USA.
Contracept Reprod Med. 2016 Feb 23;1:3. doi: 10.1186/s40834-016-0009-2. eCollection 2016.
Opportunities for medical students to place intrauterine contraception (IUC) in patients are rare. Our objective was to determine whether participation in an IUC insertion and removal simulation exercise would increase medical students' comfort level with, attitudes towards, and willingness to recommend IUC.
A prospective cohort study was undertaken in all students completing the obstetrics and gynecology clerkship at a major academic hospital during the 2010-2011 academic year. The exposure consisted of a 45-minute interactive didactic session and a 30-minute, hands-on practicum in IUC placement and removal using medical instruments and realistic pelvic models. Both levonorgestrel and Cu380A IUC devices were utilized. Participants completed a pre- and post-simulation survey instrument, designed to examine students' IUC-specific knowledge, comfort, and attitudes. Pre- and post-simulation responses were compared by McNemar's test for paired samples.
Thirty-five paired pre- and post-simulation surveys were analyzed, representing a 78 % response rate. Composite IUC-related knowledge scores increased by a median of 3 out of 10 points after the intervention ( < 0.01). Students were significantly more comfortable counseling patients about IUC as well as inserting IUC after the intervention, compared to before. Seven (20 %) students before, compared to 27 (77 %) after, agreed with the statement, "I feel comfortable placing an IUC in a patient under the supervision of an experienced doctor" ( < 0.01). Students developed significantly more favorable attitudes towards IUC through the intervention. Nineteen (54 %) participants before, compared to 27 (77 %) after, agreed with the statement, "I would recommend an IUC to my family member" ( = 0.02).
A hands-on simulation during the obstetrics and gynecology clerkship increased medical students' knowledge of and comfort with IUC and resulted in more favorable attitudes toward the method. Intrauterine contraception simulation in medical curricula may help expand utilization of this effective contraceptive method.
医学生为患者放置宫内节育器（IUC）的机会很少。我们的目的是确定参与IUC放置和取出模拟练习是否会提高医学生对IUC的舒适度、态度以及推荐IUC的意愿。
对2010 - 2011学年在一家大型学术医院完成妇产科实习的所有学生进行了一项前瞻性队列研究。干预措施包括一个45分钟的互动式教学课程和一个30分钟的实践操作，使用医疗器械和逼真的盆腔模型进行IUC放置和取出练习。左炔诺孕酮和Cu380A IUC装置均有使用。参与者完成了模拟前后的调查问卷，旨在考查学生关于IUC的特定知识、舒适度和态度。模拟前后的回答通过配对样本的McNemar检验进行比较。
分析了35对模拟前后的调查问卷，回复率为78%。干预后，与IUC相关的综合知识得分中位数从10分中提高了3分（P<0.01）。与之前相比，干预后学生在为患者提供IUC咨询以及放置IUC时明显更自在。干预前有7名（20%）学生同意“在有经验的医生监督下，我觉得为患者放置IUC很自在”这一说法，干预后有27名（77%）学生同意（P<0.01）。通过干预，学生对IUC的态度明显更积极。干预前有19名（54%）参与者同意“我会向我的家庭成员推荐IUC”这一说法，干预后有27名（77%）参与者同意（P = 0.02）。
妇产科实习期间的实践模拟提高了医学生对IUC的知识和舒适度，并使他们对该方法的态度更积极。医学课程中的宫内节育器模拟可能有助于扩大这种有效避孕方法的应用。
