Assessing simulation training for dilation and evacuation
Awarded 2012
Complex Family Planning Fellowship Research
Sloane York, MD
Northwestern University

Background: Second trimester uterine evacuation can be accomplished safely and effectively with dilation and evacuation. The Accreditation Council for Graduate Medical Education mandates routine abortion training in obstetrics and gynecology residency, but few graduate competent to perform dilation and evacuation due to limited clinical volume and lack of access to skilled teachers. Simulation-based education offers an opportunity to shorten learning curves and improve skills for residents.

The purpose of this study was to assess the utility of a novel dilation and evacuation simulator to train residents in a simulation lab and evaluate the effect of simulation-based educational intervention on resident performance in the operating room.

Methods: We created a novel second trimester dilation and evacuation simulator and have evaluated the model through three phases.

Prototype Assessment: We recruited experienced dilation and evacuation providers to test the model and evaluate whether the simulator is realistic and replicates extraction skills.

Training Assessment: Residents performed and were evaluated on 6 “cases” on the model. Procedural time and total checklist scores were assessed through repeated measures ANOVA.

Clinical Assessment: Twelve third-year residents will receive training on the simulator. After reaching a minimal passing score, they are evaluated through direct intra-operative evaluation during dilation and evacuation procedures at ≥16.0 weeks using a surgical checklist, skills assessment, and procedural time. Data collection is ongoing and inter-rater and intra-rater reliability will be assessed.

Results: Prototype assessment: Twenty-one surgeons rated the simulator as “useful” or “very useful” to teach extraction skills and for training novice surgeons.

Training assessment: Twenty-four residents participated in the training assessment. Cases were evaluated in pairs (1 and 2, 3 and 4, and 5 and 6) as feedback was provided between the second and fourth cases. There was a significant difference in total scores between the three data points made up of two cases each (F(2,40) = 13.80, P = .000). Residents scored significantly higher on the combined fifth and sixth cases than previous cases. Procedure time decreased over cases (F(2,40) = 7.12, P = .002).

Conclusions: Simulation training to teach dilation and evacuation skills is feasible to implement in a training environment. Operative assessment is ongoing to determine change in surgical skills following simulation training.