Teaching invasive perinatal procedures: assessment of a high fidelity simulator-based curriculum.
OBJECTIVE
Learning curves pose a difficult problem in the teaching of technical skills: how do you teach procedural skills without compromising patients' health? A simulator-based curriculum has been designed to minimize the risks to patients undergoing amniocentesis by shifting the learning curve away from patients and into the laboratory. This study evaluated the effectiveness of a high-fidelity simulator-based curriculum in improving the performance of amniocentesis by obstetric trainees.


METHODS
Thirty trainees received a course on the practice of amniocentesis. The curriculum consisted of a lecture, a syllabus, and a hands-on training session with the simulator. Pre- and post-training performance were evaluated with two rating scales. Training and performance evaluation were completed using the same simulator. The effectiveness of the simulator-based workshop and the effect of year of training were assessed using a two-way analysis of variance.


RESULTS
Performance scores improved from a mean score of 55% to 94% using checklist scoring and from 57% to 88% using global ratings. The two-way analysis of variance revealed a significant effect of training (F1,60 = 43.57; P < 0.001) accounting for 45% of the variance in scores, and a significant effect of experience level (F2,60 = 9.16; P < 0.001) accounting for 25% of the variance in scores.


CONCLUSIONS
A comprehensive curriculum based on a high-fidelity simulator was effective at improving skills demonstrated on the simulator. The challenge remains to establish that skills acquired on a simulator are transferable to the clinical setting.
Pittini
R
R
Department of Obstetrics and Gynecology, Surgery and Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. richard.pittini@swchsc.on.ca
Oepkes
D
D
Macrury
K
K
Reznick
R
R
Beyene
J
J
Windrim
R
R
D000649:Amniocentesis / Q000379:methods*; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008953:Models, Anatomic; D009774:Obstetrics / Q000193:education*; D009864:Ontario; D016544:Patient Simulation; D011247:Pregnancy; D012680:Sensitivity and Specificity; D013663:Teaching / Q000379:methods*; D016216:Ultrasonography, Prenatal