Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum
Introduction Despite the need for providers skilled in second-trimester dilation and evacuation (D&E) procedures, there are few second-trimester abortion training opportunities for OB/GYN residents and other health care trainees. Barriers to such training include restrictive state laws and insti...
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| Format: | Article |
| Language: | English |
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Association of American Medical Colleges
2023-08-01
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| Series: | MedEdPORTAL |
| Subjects: | |
| Online Access: | http://www.mededportal.org/doi/10.15766/mep_2374-8265.11336 |
| _version_ | 1797743379730137088 |
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| author | Leah N. Schwartz Andrea Pelletier Alisa B. Goldberg Kari Braaten Brian Donnenfeld Jennifer Muller Persephone Giannarikas Nancy Falconer Deborah Campbell Deborah Bartz |
| author_facet | Leah N. Schwartz Andrea Pelletier Alisa B. Goldberg Kari Braaten Brian Donnenfeld Jennifer Muller Persephone Giannarikas Nancy Falconer Deborah Campbell Deborah Bartz |
| author_sort | Leah N. Schwartz |
| collection | DOAJ |
| description | Introduction Despite the need for providers skilled in second-trimester dilation and evacuation (D&E) procedures, there are few second-trimester abortion training opportunities for OB/GYN residents and other health care trainees. Barriers to such training include restrictive state laws and institutional policies, lack of trained faculty, and limited procedural volume. Simulation-based D&E training is, therefore, a critical tool for OB/GYN residents and other medical professionals to achieve clinical competency. Methods This simulation for OB/GYN residents centers on a 29-year-old woman at 18 weeks gestation with intrauterine fetal demise, requiring learners to perform a second-trimester D&E and manage an unexpected postprocedural hemorrhage. We designed the simulation to be used with a high-fidelity mannequin. Personnel roles required for the simulation included an anesthesiologist, medical assistant, OR nurse, and two OB/GYN faculty. Learner performance was assessed using a pre- and postsimulation learner evaluation, a critical action checklist, and a focus group with simulation facilitators. Results Forty-nine residents participated over an 8-year period. Learners demonstrated improved competency performing a second-trimester D&E and increased confidence managing postprocedural hemorrhage after participating in this simulation. In addition, focus group participants reported that a majority of learners demonstrated confidence and effective communication with team members while performing in a decision-making role. Discussion In addition to improving learners’ clinical competency and surgical confidence for second-trimester D&E procedures, this simulation serves as a valuable instrument for the standardized assessment of learners’ performance, as well as an opportunity for all participants to practice teamwork and communication in a high-acuity setting. |
| first_indexed | 2024-03-12T14:54:39Z |
| format | Article |
| id | doaj.art-6bf532aeeffd4f9e995d40496b118365 |
| institution | Directory Open Access Journal |
| issn | 2374-8265 |
| language | English |
| last_indexed | 2024-03-12T14:54:39Z |
| publishDate | 2023-08-01 |
| publisher | Association of American Medical Colleges |
| record_format | Article |
| series | MedEdPORTAL |
| spelling | doaj.art-6bf532aeeffd4f9e995d40496b1183652023-08-15T04:00:07ZengAssociation of American Medical CollegesMedEdPORTAL2374-82652023-08-011910.15766/mep_2374-8265.11336Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training CurriculumLeah N. Schwartz0Andrea Pelletier1Alisa B. Goldberg2Kari Braaten3Brian Donnenfeld4Jennifer Muller5Persephone Giannarikas6Nancy Falconer7Deborah Campbell8Deborah Bartz9First-Year Resident, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical SchoolStatistician, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical SchoolDirector, Division of Family Planning, and Fellowship Director, Complex Family Planning, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical SchoolAssociate Fellowship Director, Complex Family Planning, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical SchoolInstructor, Department of Anesthesia, Brigham and Women's Hospital/Harvard Medical SchoolMedical Assistant, Department of Obstetrics and Gynecology, Brigham and Women's HospitalOperations Manager, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's HospitalNurse (Retired), Department of Obstetrics and Gynecology, Brigham and Women's HospitalNurse (Retired), Department of Obstetrics and Gynecology, Brigham and Women's HospitalAssociate Clerkship Director, Obstetrics and Gynecology Clerkship, and Director, Kenneth J. Ryan Program in Abortion and Family Planning, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical SchoolIntroduction Despite the need for providers skilled in second-trimester dilation and evacuation (D&E) procedures, there are few second-trimester abortion training opportunities for OB/GYN residents and other health care trainees. Barriers to such training include restrictive state laws and institutional policies, lack of trained faculty, and limited procedural volume. Simulation-based D&E training is, therefore, a critical tool for OB/GYN residents and other medical professionals to achieve clinical competency. Methods This simulation for OB/GYN residents centers on a 29-year-old woman at 18 weeks gestation with intrauterine fetal demise, requiring learners to perform a second-trimester D&E and manage an unexpected postprocedural hemorrhage. We designed the simulation to be used with a high-fidelity mannequin. Personnel roles required for the simulation included an anesthesiologist, medical assistant, OR nurse, and two OB/GYN faculty. Learner performance was assessed using a pre- and postsimulation learner evaluation, a critical action checklist, and a focus group with simulation facilitators. Results Forty-nine residents participated over an 8-year period. Learners demonstrated improved competency performing a second-trimester D&E and increased confidence managing postprocedural hemorrhage after participating in this simulation. In addition, focus group participants reported that a majority of learners demonstrated confidence and effective communication with team members while performing in a decision-making role. Discussion In addition to improving learners’ clinical competency and surgical confidence for second-trimester D&E procedures, this simulation serves as a valuable instrument for the standardized assessment of learners’ performance, as well as an opportunity for all participants to practice teamwork and communication in a high-acuity setting.http://www.mededportal.org/doi/10.15766/mep_2374-8265.11336AbortionDilation & EvacuationIntrauterine Fetal DemiseHemorrhageOB/GYNSimulation |
| spellingShingle | Leah N. Schwartz Andrea Pelletier Alisa B. Goldberg Kari Braaten Brian Donnenfeld Jennifer Muller Persephone Giannarikas Nancy Falconer Deborah Campbell Deborah Bartz Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum MedEdPORTAL Abortion Dilation & Evacuation Intrauterine Fetal Demise Hemorrhage OB/GYN Simulation |
| title | Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum |
| title_full | Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum |
| title_fullStr | Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum |
| title_full_unstemmed | Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum |
| title_short | Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum |
| title_sort | second trimester dilation and evacuation a simulation based team training curriculum |
| topic | Abortion Dilation & Evacuation Intrauterine Fetal Demise Hemorrhage OB/GYN Simulation |
| url | http://www.mededportal.org/doi/10.15766/mep_2374-8265.11336 |
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