Healthcare Simulation and Bioskills Training Center, Naval Medical Center, Portsmouth, VA 23708, USA.
Women's Health Department, Naval Medical Center, Portsmouth, VA 23708, USA.
Mil Med. 2021 Feb 26;186(3-4):421-425. doi: 10.1093/milmed/usaa285.
Lack of obstetric and gynecologic (OBGYN) procedure exposure during general surgery residency was recognized as a training gap for military general surgery residents by U.S. Navy trauma and general surgeons serving as simulation leads for the Naval Medical Center Portsmouth general surgery resident program. Program faculty requested the authors develop and implement a recurring simulation curriculum to address this training gap. The primary goal of the simulation curriculum was to increase exposure to and confidence in performing four commonly encountered OBGYN procedures in a deployed setting: spontaneous vaginal delivery (SVD), Bartholin's cyst incision and drainage with Word catheter placement, cesarean delivery, and total abdominal hysterectomy (TAH). We hypothesized that trainees exposed to the new simulation curriculum would demonstrate an increase in knowledge and confidence in these four commonly encountered OBGYN procedures.
The study utilized a pre- and postdesign to determine the efficacy of a newly developed simulation curriculum as measured by participants' knowledge and confidence levels. The annual curriculum was 4 hours in duration and included a targeted lecture followed by the administration of the four OBGYN simulation skills stations: SVD, Bartholin's, cesarean delivery, and total abdominal hysterectomy. Proctors for the simulation stations consisted of OBGYN teaching faculty who had at least 5 years of clinical teaching experience and were experienced simulation instructors. Precourse and postcourse knowledge and confidence were self-rated on a 5-point Likert scale. The learners rated the course using the Simulation Design Scale. Likert scale data were analyzed using the paired Wilcoxon rank sum test. Descriptive statistics were reported for the Simulation Design Scale. P < 0.05 was considered to be statistically significant. This project was classified as nonhuman subjects' research by the Naval Medical Center Portsmouth Institutional Review Board.
Over the 2 years since curriculum implementation, 34 trainees participated in the curriculum; no trainees have had the curriculum twice. All trainees confirmed training gaps on baseline self-assessment of knowledge and confidence of all four OBGYN procedures with the most confidence reported for SVD (2.83 mean). Self-rated knowledge and confidence levels improved significantly in all four of the simulated procedures for all 34 participants (P < 0.001). Postcurricular surveys (82% response rate, 28/34) indicated a high satisfaction with all areas of the simulation training (4.74/5.0).
The implemented curriculum increased general surgery trainees' knowledge and confidence in four commonly encountered OBGYN procedures and demonstrated a high level of learner satisfaction and sustainability. The curriculum exhibits high educational impact and could be a valuable adjunctive training for other non-OBGYN physicians who may need to provide OBGYN care in military environments.
美国海军创伤和普通外科医生作为朴茨茅斯海军医疗中心普通外科住院医师项目的模拟负责人，他们认为普通外科住院医师在妇产科（OBGYN）手术方面的经验不足是一个培训缺口。项目教师要求作者开发并实施一项重复的模拟课程来解决这一培训差距。该模拟课程的主要目标是增加在部署环境中进行四种常见的 OBGYN 手术的经验并增强信心：自然分娩（SVD）、巴氏腺囊肿切开引流术和 Word 导管放置术、剖腹产和全子宫切除术（TAH）。我们假设接受新模拟课程的学员在这四种常见的妇产科手术中的知识和信心水平会有所提高。
该研究采用了预前后测设计，以参与者的知识和信心水平来确定新开发的模拟课程的效果。年度课程持续 4 小时，包括一个有针对性的讲座，然后是四个妇产科模拟技能站的管理：SVD、巴氏腺囊肿、剖腹产和全子宫切除术。模拟站的主管由妇产科教学教师组成，他们至少有 5 年的临床教学经验，并且是有经验的模拟讲师。课前和课后的知识和信心都是自我评估的 5 分李克特量表。学习者使用模拟设计量表对课程进行评分。李克特量表数据使用配对 Wilcoxon 秩和检验进行分析。模拟设计量表的描述性统计数据报告。P<0.05 被认为具有统计学意义。朴茨茅斯海军医疗中心机构审查委员会将该项目归类为非人类研究对象。
自课程实施以来的两年中，有 34 名学员参加了课程；没有学员上过两次。所有学员都在基线自我评估中确认了所有四项妇产科手术的知识和信心存在差距，对 SVD 的信心最高（2.83 分）。所有 34 名参与者的所有四项模拟手术的自我评估知识和信心水平均显著提高（P<0.001）。课后调查（82%的回复率，28/34）表明，模拟培训的所有方面都非常满意（4.74/5.0）。
实施的课程提高了普通外科住院医师对四种常见妇产科手术的知识和信心，并显示出较高的学习者满意度和可持续性。该课程具有较高的教育影响力，可为可能需要在军事环境中提供妇产科护理的其他非妇产科医生提供有价值的辅助培训。
