A Novel Approach to Simulation-Based Perineal Repair in Undergraduate Medical Education.

INTRODUCTION: There is no formalized hands-on teaching of suturing skills for clerkship students during their dedicated obstetrics and gynaecology (OB/GYN) teaching sessions at the University of Toronto. Nevertheless, the students are exposed to suturing during gynaecologic surgery, Caesarean sections, and perineal repairs. As a result, a formal pilot workshop on knot-tying and perineal laceration repair was developed for incorporation into the third-year clerkship curriculum with the goals of increasing students' knowledge and technical skills. METHODS: Participants consisted of students enrolled in their OB/GYN clerkship rotation at St. Michael's Hospital at the University of Toronto from December 2016 to August 2017. Prior to the workshop, students' (n = 82) baseline knowledge of perineal lacerations was assessed with a pre-test quiz and their knot-tying speeds (two hand-ties and two instrument ties) were recorded. Students were then taught perineal anatomy, laceration types and repair techniques, suturing, and knot-tying. Under direct supervision, students practiced the technical skills for 45 minutes. Knowledge and knot-tying speeds were then reassessed following the educational session. RESULTS: There was a statistically significant improvement in both knowledge (51% to 71%; P < 0.05) and technical skills (258.8 seconds to 197.4 seconds; P < 0.05) after the workshop. Importantly, 94% of students "agreed" or "strongly agreed" that this method of learning was more enjoyable than traditional methods. CONCLUSIONS: This pilot project demonstrates that a formal hands-on workshop improves medical knowledge, technical skills, and student satisfaction. This has the potential for students to have increased opportunities at the bedside, with higher patient acceptance and safety.

Bridging the Gap: Incorporating Simulation into Obstetrics and Gynaecology Undergraduate Medical Education.

INTRODUCTION: Currently, simulation training is not part of the clinical clerkship rotation in obstetrics and gynaecology (OB/GYN) at the University of Toronto. Instead, students are taught formally through lectures and informally on the ward or in the operating room. This study aimed to incorporate simulation using a high fidelity postpartum hemorrhage (PPH) workshop into the teaching curriculum, with the goal of improving both medical knowledge of PPH and nontechnical skills (NTS). METHOD: A novel teaching session was introduced for the third-year clerks on their OB/GYN rotation. Students (n = 88) were invited to participate in the research component to evaluate the effectiveness of this session. Students' (n = 83) baseline knowledge of PPH and teamwork attitudes were measured using a multiple-choice questionnaire (MCQ) and the TeamSTEPPS Questionnaire. Students participated in small-group learning about PPH and NTS, followed by a high-fidelity PPH simulation using a Laerdal SimMom Mannequin in a mock operating room. Students were debriefed, followed by a different MCQ and the TeamSTEPPS Questionnaire. RESULTS: Statistically significant improvements in students' comprehension (MCQ scores 63.9% vs. 76.5%, P < 0.05) and NTS (4.35/5 vs. 4.51/5, P < 0.05) were noted after simulation. The majority (92%) of students agreed that this method of learning was more enjoyable than traditional methods. CONCLUSIONS: Simulation in undergraduate education offers an exciting alternative to deliver information that is traditionally taught with didactic sessions while incorporating essential NTS. The authors hope that this study will encourage discussion of current simulation practices across Canada and standardized simulation techniques in OB/GYN.