Managing Hemorrhage After Second-Trimester D&E: Individual Simulation Training for Ob/Gyn Residents

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Faculty Advisor:

Amy Boardman, MD


To evaluate the efficacy of case-based simulation on resident knowledge and retention for management of a rare clinical event.


Abortion is a safe procedure with the risks of complications increasing as gestational age increases. Although rare, hemorrhage is a common cause of mortality with second-trimester abortion. Teaching how to anticipate and manage any rare, potentially catastrophic clinical event is a challenge in medical education.


In our university program of 31 residents, a needs assessment identified management of hemorrhage after D&E as a desired simulation topic. Two different case-based scenarios were developed in which each resident managed the patient encounter alone. After each post-simulation debrief, residents reviewed a management algorithm and topic handout. Pre- and post-tests were completed with both simulations. The interval between the simulations and a retention post-test was approximately 2.4 months.


Twenty-five residents (81%) completed the first simulation, and 18 residents (58%) completed both simulations. Median baseline pre-test score for PGY1/2 residents was statistically different than PGY3/4s (P=.002). Overall, post-test scores were greater than pre-test scores with both simulation sessions (P<.0001). Pre-test scores of second simulation decreased slightly compared to the first post-test, but not to baseline. The retention score was unchanged from the 2nd simulation post-test (P=.26). Ninety-six percent of evaluations agreed that simulation was an effective, and desirable way to learn management of rare clinical events.


Simulation provides opportunity for resident education of rare clinical events. This low-fidelity, case-based simulation demonstrates improved baseline resident knowledge for management of post-D&E hemorrhage.

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