Abstract
Objective
To compare the skills of performing a vaginal breech (VB) delivery after hands-on
training versus demonstration.
Study design
We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on
(group 2) training session using a standardized VB management algorithm on a pelvic
training model. Subjects were tested with a 25 item Objective Structured Assessment
of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment
(SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes.
Statistics were performed using the Mann–Whitney U-test, chi-square test, and multiple linear regression analysis.
Results
172 subjects were randomized. OSATS scores (primary outcome) were significantly higher
in group 2 (n = 88) compared to group 1 (n = 84) (21.18 ± 2.29 vs. 20.19 ± 2.37, respectively; p = 0.006). The secondary outcomes GRS (10.31 ± 2.28 vs. 9.17 ± 2.21; p = 0.001), PT (214.60 ± 57.97 s vs. 246.98 ± 59.34 s; p < 0.0001), and CON (3.14 ± 0.89 vs. 2.85 ± 0.90; p = 0.04) were also significantly different between groups, favoring group 2. After 72 h, primary and secondary outcomes were not significantly different between groups.
In a multiple linear regression analysis, group assignment (odds ratio [OR] 1.60;
95% confidence interval [CI] 1.14–2.05; p < 0.0001) and gender (OR 2.91; 95% CI 2.45–3.38; p < 0.0001) independently influenced OSATS scores.
Conclusion
Hands-on training leads to a significant improvement of VB management in a pelvic
training model, but this effect was only seen in the short term.
Keywords
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Article info
Publication history
Published online: September 30, 2013
Accepted:
September 16,
2013
Received in revised form:
August 14,
2013
Received:
June 13,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
