title: Training for Norplant implant removal: assessment of learning curves and competency.
abstract: OBJECTIVE
  To determine the learning curves and rapidity with which clinicians become competent in implant removal using two Norplant removal techniques.
  
  
  METHODS
  Twenty-four physicians, none of whom were experienced in the use of Norplant implants, were randomly assigned to learn either the "U" removal technique or the standard technique. The physicians in the two groups received identical training in all other respects. Each physician then performed ten supervised removals. Removal times, procedure problem rates, and the number of procedures performed by the clinicians before they were judged "competent" were assessed for both groups.
  
  
  RESULTS
  Data from 240 removals were analyzed. Mean removal times were 38% faster in the "U" group than in the standard group. None of the "U" group procedures took longer than 20 minutes, compared with 11% of removals in the standard group (P < .001). The mean number of cases required before the provider consistently performed all steps adequately was significantly (P < .02) higher in the standard group (5.8 cases) than in the "U" group (3.9 cases).
  
  
  CONCLUSIONS
  Using competency-based training methods, the "U" removal technique was learned easily by inexperienced clinicians. It appears to offer significant improvements in speed and achievement of proficiency over the standard technique recommended by the manufacturer. Large-scale programs should consider using competency-based training and the "U" technique as the removal method of choice when providing training in implant removal.
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Blumenthal
authors.forename: L
authors.initials: L
authors.lastname: Gaffikin
authors.forename: L
authors.initials: L
authors.lastname: Garrikin
authors.forename: B
authors.initials: B
authors.lastname: Affandi
authors.forename: A
authors.initials: A
authors.lastname: Bongiovanni
authors.forename: J
authors.initials: J
authors.lastname: McGrath
authors.forename: G
authors.initials: G
authors.lastname: Glew
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003267:Contraception / Q000379:methods; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004501:Education, Medical; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel