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Licensed Unlicensed Requires Authentication Published by De Gruyter September 7, 2019

Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program

  • Cécile Monod EMAIL logo , Johanna Buechel , Stefan Gisin , Aisha Abo El Ela , Deborah R. Vogt and Irene Hoesli

Abstract

Background

Although cesarean sections at full dilatation are increasing, training in delivering a deeply impacted fetal head is lacking among obstetricians. The purpose of the study was to implement and evaluate a theoretical and simulation-based training program for this obstetrical emergency.

Methods

We developed a training program consisting of a theoretical introduction presenting a clinical algorithm, developed on the basis of the available literature, followed by a simulation session. We used the Kirkpatrick’s framework to evaluate the program. A questionnaire was distributed, directly before, immediately and 6 weeks after the training. Self-perceived competencies were evaluated on a 6-point Likert scale. Pre- and post-test differences in the Likert scale were measured with the Wilcoxon signed rank test. Additionally, the training sessions were video recorded and rated with a checklist in relation to how well the algorithm was followed.

Results

Eleven residents and eight senior physicians took part to the training. More than 40% of participants experienced a comparable situation after the course during clinical work. Their knowledge and self-perceived competencies improved immediately after the training program and 6 weeks later. Major improvements were seen in the awareness of the algorithm and in the confidence in performing the reverse breech extraction (14.3% of the participants felt confident with the maneuver in the pre-training assessment compared with 66.7% 6 week post-training).

Conclusion

Our theoretical and simulation-based training program was successful in improving knowledge and confidence of the participants in delivering a deeply impacted fetal head during a cesarean section performed at full dilation.


Corresponding author: Cécile Monod, MD, Department of Gynecology and Obstetrics, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland, Tel.: 0041613285310
aCécile Monod and Johanna Buechel contributed equally to this work.

Acknowledgments

We are very grateful to Ms. Corinne Urech, psychologist at our department of Gynecology and Obstetrics, who critically reviewed the questionnaires.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2019-0216).


Received: 2019-06-15
Accepted: 2019-08-14
Published Online: 2019-09-07
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

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