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

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Abstract

Faculty Advisor:

Amy Boardman, MD

PURPOSE:

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

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

DISCUSSION:

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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