Maria W E Frenken1, Laura D de Wit-Zuurendonk2, Sarah Rae Easter3, Simone M T A Goossens4, S Guid Oei4. 1. Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands. Electronic address: marion.frenken@mmc.nl. 2. Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), Eindhoven, The Netherlands. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States. 4. Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
Abstract
OBJECTIVE: It is important to train clinicians to maintain and optimise maternal and neonatal outcomes after vaginal twin delivery. Simulation-based training provides opportunities for training in a realistic way without harming patients. The aim of this study is to evaluate the effect of simulation-based training concerning twin vaginal delivery on knowledge and comfort of obstetrician-gynaecologists. STUDY DESIGN: Obstetrician-gynaecologists participated in a twin vaginal delivery simulation between March 2018 and May 2019. Simulation-based training consisted of standardized patient interviews, didactic sessions and three different simulation-based scenarios: internal podalic version and breech extraction, assisted vaginal delivery and vaginal breech delivery with problems of aftercoming head. Pre- and posttraining, participants were asked to fill out questionnaires exploring knowledge concerning vertex-vertex twin deliveries and vertex-nonvertex twin deliveries, level of comfort performing various obstetric manoeuvres and counselling on mode of delivery for women pregnant with twins. Our primary outcome of interest was a change in knowledge or comfort surrounding vaginal twin delivery after completion of the simulation-based training. RESULTS: The estimated median number of vaginal twin deliveries performed by the participating thirty-four obstetrician-gynaecologists was 50 (IQR 20-100). Significant improvements were seen in knowledge regarding twin deliveries with vertex-nonvertex presentation (p < 0.01). In two of three questions regarding twin delivery with vertex-vertex presentation significant improvements were seen as well (p < 0.01). Before training, 40.6% of participants felt comfortable to perform internal podalic version compared to 91.2% afterwards (p < 0.01). Comfort with breech extraction increased from 69.7% to 97.1% pre- and posttraining, respectively (p < 0.01). Before training only 55.9% would strongly counsel patients towards vaginal twin delivery as opposed to 73.5% after training (p = 0.07). CONCLUSIONS: Simulation-based training results in beneficial effects on knowledge and comfort concerning vaginal twin deliveries for obstetrician-gynaecologists. This training suggested a potential impact on provider practice with a more favourable attitude towards twin vaginal birth.
OBJECTIVE: It is important to train clinicians to maintain and optimise maternal and neonatal outcomes after vaginal twin delivery. Simulation-based training provides opportunities for training in a realistic way without harming patients. The aim of this study is to evaluate the effect of simulation-based training concerning twin vaginal delivery on knowledge and comfort of obstetrician-gynaecologists. STUDY DESIGN: Obstetrician-gynaecologists participated in a twin vaginal delivery simulation between March 2018 and May 2019. Simulation-based training consisted of standardized patient interviews, didactic sessions and three different simulation-based scenarios: internal podalic version and breech extraction, assisted vaginal delivery and vaginal breech delivery with problems of aftercoming head. Pre- and posttraining, participants were asked to fill out questionnaires exploring knowledge concerning vertex-vertex twin deliveries and vertex-nonvertex twin deliveries, level of comfort performing various obstetric manoeuvres and counselling on mode of delivery for women pregnant with twins. Our primary outcome of interest was a change in knowledge or comfort surrounding vaginal twin delivery after completion of the simulation-based training. RESULTS: The estimated median number of vaginal twin deliveries performed by the participating thirty-four obstetrician-gynaecologists was 50 (IQR 20-100). Significant improvements were seen in knowledge regarding twin deliveries with vertex-nonvertex presentation (p < 0.01). In two of three questions regarding twin delivery with vertex-vertex presentation significant improvements were seen as well (p < 0.01). Before training, 40.6% of participants felt comfortable to perform internal podalic version compared to 91.2% afterwards (p < 0.01). Comfort with breech extraction increased from 69.7% to 97.1% pre- and posttraining, respectively (p < 0.01). Before training only 55.9% would strongly counsel patients towards vaginal twin delivery as opposed to 73.5% after training (p = 0.07). CONCLUSIONS: Simulation-based training results in beneficial effects on knowledge and comfort concerning vaginal twin deliveries for obstetrician-gynaecologists. This training suggested a potential impact on provider practice with a more favourable attitude towards twin vaginal birth.