There are several reasons why medical students may have limited exposure to aspects of obstetrics during their clerkship. The short duration of the rotation, the reduced availability of patients willing to have medical students observe and perform obstetrical techniques, and the potential for unpredictable, serious complications to occur in seconds are all conditions that conspire to create reduced learning opportunities for clerks. Unfortunately, it is the very same practical opportunities that medical students are excluded from that serve to increase their understanding and interest in the speciality. Given the successful implementation simulation education in residency programs, its use in undergraduate medical education may serve as a practical solution to the marginalization of medical students during their obstetrics rotation. The current curriculum was designed for a simulation-based workshop during the first week of the obstetrics clerkship to instruct students in the diagnosis of labour and gain an appreciation for the decisions that are made as part of intra-partum management.
Prior to the development of this curriculum, formal teaching for clerkship students in obstetrics and gynaecology at our institution consisted solely of didactic lectures. The objective of this simulation-based innovation was to alleviate the students’ anxiety at the beginning of their rotation through providing opportunities to practice clinical skills necessary for success during clerkship. Furthermore, it was thought that engaging the students early on in their clinical training could help to foster an interest in pursuing postgraduate training in obstetrics and gynecology.
This workshop was developed in accordance with the educational objectives described in the US-based Association of Professors of Gynecology and Obstetrics (APGO). This simulation follows a single obstetrical patient whose clinical course is followed by the students from presentation to the obstetrical assessment unit until spontaneous vaginal delivery and immediate postpartum care. Through use of a high-fidelity mannequin, this simulation provides students the opportunity to examine the patient throughout the course of her labour to assess dilation and ultimately perform a vaginal delivery. The workshop also incorporates elements of interactive teaching and round table discussion that encourages student participation.
You will find a full curriculum document which can be used as an instructors manual, as well as a pre- and post-test which can be used to assess learning during the workshop, and a hand-out for students summarizing the objectives of the session.
This workshop has been in use at our institution since the 2008-2009 and has been incredibly well-received by students, as evidenced by anonymous written evaluations. Their confidence and knowledge-base during their first days on service in labour & delivery are noticeably improved, and we documented successful learning on a pre- and post-test comparison, as published in "Medical Education" in 2010.
- To take a focused history from an obstetrical patient presenting in labour.
- To perform a focused physical exam on an obstetrical patient in labour.
- To synthesize the findings on history and physical so as to confirm or rule-out a diagnosis of labour.
- To define labour, and all of its stages.
- To decide whether or not to admit a patient in labour to the case room.
- To take a focused history from a patient with hypertension, related to the diagnosis of pre-eclampsia.
- To perform a focused physical exam on a patient with suspected pre-eclampsia.
- To order appropriate investigations for a patient with pre-eclampsia.
- To describe the options available to augment labour (e.g., artificial rupture of the membranes, oxytocin infusion).
- To describe the non-pharmacologic and pharmacologic pain control options available to patients in labour and when they are appropriate (e.g., narcotics, nitrous oxide, epidural, massage, Jacuzzi, birthing ball).
- To demonstrate the technique of artificial rupture of membranes and placement of an internal fetal monitor.
- To interpret the fetal heart rate monitor tracing, including baseline, variability, accelerations and decelerations.
- To discuss the management of the second stage of labour.
- To demonstrate the proper technique of spontaneous vaginal delivery and management of the third stage of labour.
- To describe the indications and criteria for operative vaginal delivery, and be able to demonstrate the technique of forceps or vacuum delivery on a mannequin.
- To demonstrate the maneuvers required to manage shoulder dystocia.
- To describe the indications for cesarean section.
None to report.
This research was funded by University of Ottawa.
Posner G, Nakajima A. Introducing Simulation into the Undergraduate Obstetrics Curriculum. Workshop presented at: Association of Professors of Gynecology and Obstetrics (USA), Faculty Development Seminar; January 2011; Amelia Island, FL.
Posner G, Nakajima A. The Development and Implementation of an Undergraduate Curriculum in Obstetrical Simulation. Poster presented at: International Meeting on Simulation in Healthcare; January 2010; Phoenix, Arizona.
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