(205) Simulation-based mastery learning improves physical exam-indicated cerclage skills among OB/GYN residents

The use of physical exam-indicated cerclage (PEIC) has been associated with a reduction in perinatal morbidity and prolonged gestational latency. However, it is a technically challenging, infrequent procedure with associated risks. Simulation-based mastery learning (SBML) is an evidence-based teaching modality that has been shown to improve competency among medical trainees, especially for low frequency, high acuity procedures. We aimed to develop a SBML curriculum to teach PEIC placement to first and second-year OB/GYN residents.

Study Design:

We developed a SBML curriculum for cervical cerclage placement for first and second-year OB/GYN residents in conjunction with a high-fidelity, 3D-printed silicone cerclage model for simulation use (Figure 1). The curriculum included pre-simulation self-directed reading; a baseline assessment of knowledge and skills; in-person didactics immediately preceding a simulation session intended for deliberate practice; and a final assessment at the end of the session. Baseline and final assessments consisted of a 30-item checklist created using the Mastery-Angoff method with a pre-set minimum passing score (MPS) of 83%. If trainees were not able to meet the MPS, they continued to deliberately practice skills in the simulation session until the MPS was achieved. Chi-square and Fisher’s exact tests were used to compare categorical variables, and paired t-test was used to compare baseline and final MPS checklist scores. Statistical significance was set at p< 0.05.

Results: Of 24 eligible first and second-year OB/GYN residents, 19 consented to participate in the SBML session. Prior to the simulation session, no residents met the minimum passing score of 25/30 (83%). The mean baseline assessment MPS was 38% (SD = 8.5). After successful completion of the simulation sessions, all residents met the minimum passing score, with a mean MPS of 95% (SD = 1.6) (p < 0.01) (Figure 2).

Conclusion:

A simulation-based mastery learning curriculum improved knowledge and procedural competence in PEIC placement among first and second-year OB/GYN residents.