Simulation-based teaching for instrumental delivery with forceps: a systematic scoping review
Abstract
Introduction: The acquisition of skills for attending forceps-assisted deliveries has become increasingly challenging due to the global decline in instrumental delivery rates. Thus, optimizing teaching strategies and methods for these procedures in Obstetrics and Gynecology residents has become essential. Objective: To present the teaching methods reported in the literature for forceps-assisted deliveries and their contribution to skill acquisition, confidence building, and learning among residents. Materials and Methods: A systematic review of the literature was conducted following the PRISMA Extension for Scoping Reviews protocol. Searches were performed in the WOS and SCOPUS databases, including original articles published in Spanish and English without temporal limitations, focused on teaching methods or models for forceps-assisted deliveries. Articles addressing the research objective were selected, and the authors independently reviewed and synthesized the extracted information. Results: Six studies were included and categorized into three themes: i) Types of teaching methods: High- and low-fidelity simulations and integrative approaches combining simulations with theoretical classes were highlighted. ii) Effectiveness in skill acquisition and participant perceptions: Significant improvements in technical skills, increased confidence, and high satisfaction levels among residents were observed. These methods also contributed to better clinical outcomes for patients. iii) Patterns and development of educational tools: Advanced simulators allowed to replicate clinical scenarios and optimize the forces applied during procedures, and the real time feedback led to the improvement of error corrections. Conclusions: This systematic review underscores the critical role of simulation-based teaching methods and structured curricula in improving both the technical competence and confidence of residents in performing forceps-assisted deliveries. These findings highlight the importance of incorporating such methods to address the current gaps in clinical exposure and ensure the development of proficient obstetricians.
Downloads
Metrics
References
Black M, Murphy DJ. Forceps delivery for non-rotational and rotational operative vaginal delivery. Best Pract Res Clin Obstet Gynaecol. 2019, 56, 55-68. https://doi.org/10.1016/j.bpobgyn.2019.02.002.
Lopéz-Aceitón M, Espinosa-Serrano M, Guzmán-Rojas R. Experiencia de parto instrumental con vacuum en Hospital Público de Santiago de Chile. Rev Chil Obstet Ginecol. 2024, 89(1), 25-31. https://doi.org/10.24875/rechog.23000098.
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Dashe, J. S., Hoffman, B. L., Spong, C. Y., & Sheffield, J. S. (2022). Chapter 29: Operative vaginal delivery. Williams Obstetrics (26.ª ed.). McGraw-Hill.
Rozo-Agudelo N, Daza-Barrera SC. Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019: Population registry-based cross-sectional study. Rev Colomb Obstet Ginecol. 2022, 73(4), 358-368. https://doi.org/10.18597/rcog.3878.
American College of Obstetricians and Gynecologists. Ethical Decision Making in Obstetrics and Gynecology. ACOG Committee Opinion No. 390. Obstet Gynecol. 2007, 110(6), 1479-1487. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/12/ethical-decision-making-in-obstetrics-and-gynecology
Ashcroft J, Blakely C, Wong MD. Nonmaleficence in Medical Training: Balancing Patient Safety and Trainee Education. Int J Med Educ. 2019, 10, 207-212. https://doi.org/10.5116/ijme.5d9e.8f08
United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects 2022: Summary of Results. UN DESA/POP/2022/TR/NO. 3; 2022. Accessed [2024 Oct 1]. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf
National Center for Health Statistics. Vital statistics data available online: Natality public use file and CD-ROM. Hyattsville, MD: U.S. Department of Health and Human Services; 1990. Available at: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm. Accessed [2024 Oct 1].
National Center for Health Statistics. Vital statistics data available online: Natality public use file and CD-ROM. Hyattsville, MD: U.S. Department of Health and Human Services; 2015. Available at: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm. Accessed [2024 Oct 1].
Zhou Y, Li H, Zhu L, Li Z, Zhang Y, Liu J. [Secular trends of operative vaginal delivery in southern and northern China during 1993-2010]. Zhonghua Yi Xue Za Zhi. 2014, 94(45), 3599-602. Chinese. https://caod.oriprobe.com/articles/43566063/Secular_trends_of_operative_vaginal_delivery_in_so.htm
Wang B, Shi Q, Wang Y, Li N, Shi L. National survey on midwifery practice in health facilities in China. Chin J Obstet Gynecol. 2007, 42, 305–308. https://pubmed.ncbi.nlm.nih.gov/17673041/
Hou L, Li G, Zou L, et al. Cesarean delivery rate and indications in mainland China: a cross sectional study in 2011. Chin J Obstet Gynecol. 2014, 49, 728–735. https://pubmed.ncbi.nlm.nih.gov/25537242/
Euro-Peristat Project. European Perinatal Health Report. Core indicators of the health and care of pregnant women and babies in Europe in 2015. 2018. Available at: www.europeristat.com. Accessed [2024 Oct 1].
Euro-Peristat Project. European Perinatal Health Report. Core indicators of the health and care of pregnant women and babies in Europe from 2015 to 2019. 2020. Available at: www.europeristat.com. Accessed [2024 Oct 1].
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final Data for 2016. Natl Vital Stat Rep. 2018, 67(1), 1-55. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf
Osterman MJK, Martin JA. Trends in low-risk cesarean delivery in the United States, 1990-2013. Natl Vital Stat Rep. 2014, 63(6), 1-16. https://pubmed.ncbi.nlm.nih.gov/25383560/
Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2023. Vital Statistics Rapid Release. 2024, (35). https://doi.org/10.15620/cdc/151797. https://www.cdc.gov/nchs/data/vsrr/vsrr035.pdf
Kozhimannil KB, Law MR, Virnig BA. Cesarean delivery rates vary tenfold among US hospitals: reducing variation may address quality and cost issues. Health Aff (Millwood). 2013, 32(3), 527-535. https://doi.org/10.1377/hlthaff.2013.0001.
American College of Obstetricians and Gynecologists; Society of Maternal-Fetal Medicine; Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014, 123(3), 693-711. https://doi.org/10.1016/j.ajog.2014.01.026
Hirshberg A, Srinivas SK. Role of operative vaginal deliveries in prevention of cesarean deliveries. Clin Obstet Gynecol. 2015, 58(2), 256-262. https://doi.org/10.1097/GRF.0000000000000107
O’Mahony F, Hofmeyr GJ, Menon V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 2010, (11), CD005455. https://doi.org/10.1002/14651858.CD005455.pub2.
Rose K, Kwan L, Pluym ID, Zhang H, Han CS, Afshar Y. Forceps-assisted vaginal delivery: the landscape of obstetrics and gynecology resident training. J Matern Fetal Neonatal Med. 2019, 34(18), 3039–3045. https://doi.org/10.1080/14767058.2019.1677593.
Dotters-Katz SK, Gray B, Heine RP, Propst K. Resident Education in Complex Obstetric Procedures: Are We Adequately Preparing Tomorrow's Obstetricians?. Am J Perinatol. 2020, 37(11), 1155-1159. https://doi.org/10.1055/s-0039-1692714
Bennett C, Chambers LM, Yao M, Chien E, Berghella V. Reported case numbers and variability in delivery route and volume by obstetrics and gynecology residents from 2003 to 2019. Am J Obstet Gynecol MFM. 2021, 3(5), 100398. https://doi.org/10.1016/j.ajogmf.2021.100398.
Accreditation Council for Graduate Medical Education. Obstetrics and Gynecology Case Logs: National Data Report (2022-2023). Chicago, IL: Accreditation Council for Graduate Medical Education; 2023. https://apps.acgme.org/ads/Public/Reports/CaselogNationalReportDownload?specialtyId=40&academicYearId=29. Accessed [2024 Oct 1].
Accreditation Council For Graduate Medical Education. Minimum numbers: obstetrics and gynaecology. J Grad Medical Education. 2018. https://www.acgme.org/globalassets/pfassets/programresources/ obgyncaseloginfo.pdf (2022).
Andrews SE, Alston MJ, Allshouse AA, Moore GS, Metz TD. Does the number of forceps deliveries performed in residency predict use in practice?. Am J Obstet Gynecol. 2015, 213(1), 93.e1-93.e4. https://doi.org/10.1016/j.ajog.2015.03.025
Dávila-Cervantes A. Simulación en Educación Médica. Investig Educ Méd. 2014, 3(10), 100-105. https://doi.org/10.1016/S2007-5057(14)72733-4.
Rognoni G, Benet P, Castro A, Gomar S, Villalonga R, Zorrilla J. La simulación clínica en la educación médica: Ventajas e inconvenientes del aprendizaje al lado del paciente y en entorno simulado. Med Clin Pract. 2024, 7, 100459. https://doi.org/10.1016/j.mcpsp.2024.100459.
Satin AJ. Simulation in obstetrics. Obstet Gynecol. 2018 ,132(1), 199–209. https://doi.org/10.1097/AOG.0000000000002682.
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018, 169(7), 467-473. https://doi.org/10.7326/M18-0850
Daniels K, Lipman S, Harney K, Arafeh J, Druzin M. Use of simulation based team training for obstetric crises in resident education. Simul Healthc. 2008, 3(3), 154-160. https://doi.org/10.1097/SIH.0b013e31818187d9
Moreau R, Pham MT, Brun X, Redarce T, Dupuis O. Simulation of an instrumental childbirth for the training of the forceps extraction: control algorithm and evaluation. IEEE Trans Inf Technol Biomed. 2011, 15(3), 364-372. https://doi.org/10.1109/TITB.2011.2107746
Rose K, Jensen K, Guo R, Afshar Y. Simulation to Improve Trainee Skill and Comfort with Forceps-Assisted Vaginal Deliveries. AJP Rep. 2019, 9(1), e6-e9. https://doi.org/10.1055/s-0039-1677736
Becker DA, Blanchard CT, Szychowski JM, Rogers SL, Brumfield CG, Subramaniam A. Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation. Am J Perinatol. 2020, 37(13), 1296-1300. https://doi.org/10.1055/s-0040-1710543
Gossett DR, Gilchrist-Scott D, Wayne DB, Gerber SE. Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma. Obstet Gynecol. 2016, 128(3), 429-435. https://doi.org/10.1097/AOG.0000000000001533
Wang X, Song Z, Chen X, et al. Rapid cycle deliberate practice: application in forceps simulation training for gynecology and obstetrics residents. Ann Med. 2024, 56(1), 2301596. https://doi.org/10.1080/07853890.2023.2301596
Zeng Q, Wang K, Liu W, et al. Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials. BMC Med Educ. 2023, 23, 664. https://doi.org/10.1186/s12909-023-04654-x.
Moya P, Ruz M, Parraguez E, Carreño V, Rodríguez AM, Froes P. Efectividad de la simulación en la educación médica desde la perspectiva de seguridad de pacientes. Rev Med Chil. 2017, 145(4), 514-526. https://doi.org/10.4067/S0034-98872017000400012.
Broch M, Castellanos-Ortega Á. Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente? Med Intensiva. 2024. https://doi.org/10.1016/j.medin.2024.03.017
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2018, 132(3), e87-e102. https://doi.org/10.1097/AOG.0000000000002841.
Magee MJ, Farkouh-Karoleski C, Rosen TS. Improvement of Immediate Performance in Neonatal Resuscitation Through Rapid Cycle Deliberate Practice Training. J Grad Med Educ. 2018, 10(2), 192-197. https://doi.org/10.4300/JGME-D-17-00467.1
Swinger N, Hocutt G, Medsker BH, et al. Rapid cycle deliberate practice versus traditional simulation for training extracorporeal membrane oxygenation specialists in circuit air emergency management: a randomized trial. Simul Healthc. 2022, 17(1), e28–e37. https://doi.org/10.1097/SIH.0000000000000562
Kaczorowski J, Levitt C, Hammond M, et al. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Fam Med. 1998, 30(10), 705-711. https://pubmed.ncbi.nlm.nih.gov/9827341/
-
Abstract207
-
pdf (Español (España))89
-
Anexo I (Español (España))5
-
pdf28
-
Annex I2
Copyright (c) 2024 Servicio de Publicaciones de la Universidad de Murcia
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the economic rights (copyright) of the published works and favors and allows them to be reused under the use license indicated in point 2.
2. The works are published under a Creative Commons Attribution-NonCommercial-NoDerivative 4.0 license.
3. Self-archiving conditions. Authors are allowed and encouraged to disseminate electronically the pre-print versions (version before being evaluated and sent to the journal) and / or post-print (version evaluated and accepted for publication) of their works before publication , since it favors its circulation and earlier diffusion and with it a possible increase in its citation and reach among the academic community.
