Hunkler Kiley, Boedeker David, Gill Elizabeth, Simpkins Katelyn, Shvartsman Katerina, Brown Jill, Drayer Sara
Fellow, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center; Fellow, Reproductive Endocrinology and Infertility, National Institute of Child Health and Human Development, National Institutes of Health.
Fourth-Year Resident, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center.
MedEdPORTAL. 2025 Jan 21;21:11489. doi: 10.15766/mep_2374-8265.11489. eCollection 2025.
The future of training in second trimester surgical abortions with dilation and evacuation (D&E) procedures faces ongoing legal and political scrutiny; thus, adjuncts to standard clinical experiences are exceedingly important. We sought to build medical trainees' surgical familiarity with D&Es using a realistic simulation model.
The simulation began with an instructional video reviewing accessible and affordable materials used to build the fetal model (vaginal swabs, styrofoam ball, and putty) and the uterine model (collapsible water bottle). Required personnel roles included surgeon, surgical assistant, and facilitator. A standardized rubric was used to evaluate learners' mastery of procedural learning objectives, and a pre- and postsimulation assessment measured learners' knowledge and confidence before and after the activity. Consistency between iterations was maintained with use of standardized prompts and lectures. Total time for the activity, including setup and debrief, was 1 hour.
Eighteen residents, medical students, and attendings participated in the simulation, and 100% completed the assessment. There was a demonstrated improvement in clinical knowledge of D&E steps (56% presimulation vs. 94% postsimulation, < .001) and increased surgical confidence in performing D&Es after participating in the simulation (28% presimulation vs. 89% postsimulation, < .001). The participants with prior clinical experience in performing D&Es rated the fetal, uterine, and cervical models as realistic components in the simulation.
A gap now exists in access to clinical D&E training. This low-fidelity D&E simulation is a training tool that can fill this gap and improve learners' familiarity with this surgical procedure.
孕中期扩张和排空（D&E）手术流产培训的未来面临持续的法律和政治审查；因此，标准临床经验的辅助手段极为重要。我们试图使用逼真的模拟模型来培养医学实习生对D&E手术的操作熟悉度。
模拟开始时播放一段教学视频，介绍用于制作胎儿模型（阴道拭子、泡沫塑料球和油灰）和子宫模型（可折叠水瓶）的易得且经济实惠的材料。所需人员角色包括外科医生、手术助手和协调员。使用标准化评分标准评估学习者对程序学习目标的掌握情况，模拟前后的评估测量学习者在活动前后的知识和信心。通过使用标准化提示和讲座来保持各次模拟之间的一致性。该活动的总时长，包括准备和总结，为1小时。
18名住院医师、医学生和主治医师参与了模拟，100%完成了评估。D&E步骤的临床知识有明显提高（模拟前为56%，模拟后为94%，<0.001），参与模拟后进行D&E手术的操作信心增强（模拟前为28%，模拟后为89%，<0.001）。有D&E临床经验的参与者将胎儿、子宫和宫颈模型评为模拟中的逼真组件。
目前在临床D&E培训的获取方面存在差距。这种低保真度的D&E模拟是一种培训工具，可以填补这一差距并提高学习者对该手术程序的熟悉度。
