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Simulation training and resident performance of singleton vaginal breech delivery.

Deering S, Brown J, Hodor J, Satin AJ

Madigan Army Medical Center, Tacoma, Washington, USA. deering95@hotmail.com

OBJECTIVE: To determine whether simulation training improves resident competency in the management of a simulated vaginal breech delivery. METHODS: Without advance notice or training, residents from 2 obstetrics and gynecology residency programs participated in a standardized simulation scenario of management of an imminent term vaginal breech delivery. The scenario used an obstetric birth simulator and human actors, with the encounters digitally recorded. Residents then received a training session with the simulator on the proper techniques for vaginal breech delivery. Two weeks later they were retested using a similar simulation scenario. A physician, blinded to training status, graded the residents' performance using a standardized evaluation sheet. Statistical analysis included the Wilcoxon signed rank test, McNemar chi2, regression analysis, and paired t test as appropriate with a P value of less than .05 considered significant. RESULTS: Twenty residents from 2 institutions completed all parts of the study protocol. Trained residents had significantly higher scores in 8 of 12 critical delivery components (P < .05). Overall performance of the delivery and safety in performing the delivery also improved significantly (P = .001 for both). CONCLUSION: Simulation training improved resident performance in the management of a simulated vaginal breech delivery. Performance of a term breech vaginal delivery is well suited for simulation training, because it is uncommon and inevitable, and improper technique may result in significant injury. LEVEL OF EVIDENCE: II-2.

Published 5 January 2006 in Obstet Gynecol, 107(1): 86-9.
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