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Expert assessment of an audio and force feedback birthing simulator: a questionnaire based survey Wulf J *, Lüdemann C , Burgkart R , Obst T , Riener R 1 3B Scientic GmbH, Hamburg, Germany TU München, Lehrstuhl für Orthopädie und Unfallchirurgie, Munich, Germany ETH and University Zurich, Sensory-Motor Systems Lab, Zurich, Switzerland * Corresponding author contact: Joerg.Wulf@3bscientic.com Introduction Very little is known regarding the value of birthing simulators in student education, residency and postgraduate obstetric curriculum especially for teaching operative vaginal delivery. The purpose of this paper is to validate the use of a force and audio feedback birthing simulator SIMone™ (3B Scientic GmbH, Hamburg Germany). A questionnaire based survey is performed to ascertain the opinion of obstetricians and gynaecologists on this topical issue. By means of the survey, expert’s experience, motivations and possible barriers to simulation based education in obstetrics are taken into account. We present the rst results that will provide evidence and that will underline the use of birthing simulators and therefore optimize clinical hands-on training. were considered as relevant scoring parameters (1, very unrealistic; 3, neutral; 5, very realistic). Statistics were performed using SPSS software version 15 (SPSS, Chicago, IL). Figure 7: assessment of the usefulness of the simulator SIMone™ The application of simulators in obstetrics/gynecology is useful? strongly agree strongly disagree Figure 2: screen capture showing cardiotocogram, partogram and fetal head’s positioning Figure 8: assessment of accuracy of general anatomy of the simulator SIMone™ very accurate very inaccurate How is the degree of reality of the simulator? very high Figure 4: forceps delivery Results The questionnaire based assessment involved a total number of participants of n=53, which consisted of n=35 (65%) interns and n=13 (24%) residents in obstetrics/gynaecology (Figure 5). On average during their career, the participants performed 1128,25 assistances with a normal delivery (std.dev.: 3134,71), 240, 02 caesarean section (std.dev.: 752,11) Figure 1: and 74,78 vacuum extractions (std.dev.: 167,35). The average number of the delivery simulator SIMone™ performed forceps deliveries was comparatively low at 52,75 interventions (std.dev.: 189,62) (Figure 6). Over 2/3 of all participants strongly agreed, that simulators in obstetric training in general were useful. Only two participants disagreed or strongly disagreed (Figure 7). The delivery simulator SIMone™ [1] is a model of a female abdomen with In most cases the general anatomical accuracy was considered as either a vulva and the Spinae ischiadicae as landmarks. Inside the model there is very accurate or accurate (Figure 8). A very high or high degree of reality a foetal head with a sagittal suture and fontanelle for determining the po- of the simulator SIMone™ was reported by 39 participants (83, 0%) of our sition and approach of the head (Figure 1). survey (Figure 9). The overall assessment of the quality of the simulator A touchscreen (Figure 2) shows a corresponding image of the fetal head’s SIMone™ in 93, 3 % was considered as very good or good. There was no positioning and rotation within the pelvis. By means of various scenarios negative statement concerning this item (Figure 10). different birthing processes can be simulated. CTG, partogram and docuFinally 96, 1% of all participants would recommend the SIMone™ to mentations (results, anamnesis) are presented as well as possible interven- colleagues (Figure 11). tions, i.e. vacuum extraction (Figure 3) and forceps extraction (Figure 4). The monitoring software provides information in response to the manipuother no answer n=4; 7,5% n=1; 1,9% lation of the foetal head in the context of force-feedback. The speed and resistance shown during pulling correspond with a real situation. During the different delivery scenarios, the user of the simulator assesses internship resident the course of the delivery and considers all the necessary measures, such (obstetrics/ (obstetrics/ gynecology) gynecology) n=35; 65% n=13; 24% as the recognising the correct moment for a forceps delivery. The simulation also supports audio aspects. A loudspeaker emits the foetal heartbeat of the CTG device, as well as the respiratory sounds and exn=53 perience of pain of the “mother” as a consequence of the delivery and the Figure 5: actions of the person assisting in the delivery respectively. medical qualication of participants A questionnaire based survey of experiences, perceptions, motivations and perceived attitude to simulation-based education in instrumental delivery was designed and distributed to interns, obstetricians and gynaecologists attending a hands- on workshop (Perinatalsymposium, November 16th - November 18th 2007, Universitätsklinikum für Frauenheilkunde und Geburtshilfe, Medizinische Privatuniversität Salzburg, Austria) and a conference (23th German Conference of Perinatal Medicine, November 29th – December 1st 2007, ICC Berlin, Germany). Our expert assessment survey uses a 5 -point Likert-scale [2] (1, strongly disagree; 3, neutral; 5, strongly agree) for scoring different items. More than other aspects were anatomic- Figure 6: al and clinical delity, i.e. transvaginal examination of fetal head station performed interventions during the career of participants Figure 9: assessment of degree of reality of the simulator SIMone™ How do you assess the accurracy of general anatomy of the simulator? Figure 3: vacuum extraction Figure 10: assessment of general quality of the simulator SIMone™ How do you assess the general quality of the simulator? very good Figure 11: tendency to recommend the simulator SIMone™ to colleagues Would you recommend the simulator to colleagues? strongly agree strongly disagree Conclusion The measurement of opinions is described as reliable and reproducible as other biometric techniques [3]. Our validation study strongly suggests, that simulators in medical education have utility in obstetrics and gynaecology. The results show, that SIMone™ is able to perform realistic and interactive simulations of forceps delivery, vacuum extraction as well as normal delivery. According to the participants’s assessments there is a good accuracy of anatomical conditions. Furthermore the simulator SIMone™ provides an opportunity to simulate birth scenarios and complications so that the trainee can practice more frequently than they would be able to do with seldom real clinical situations Literature [1] Obst T, Burgkart R, Ruckhäberle E, Riener R: The delivery-simulator: a new application for medical VR. Stud. Health Technol. Inform (2004) 98:281-7 [2] Likert R: Rensis Liket on managing human assets. Bull Train (1978), 3:1-4 [3] Smith BH, Penny KI, Purves C, et al.: The chronic Pain grade questionnaire: Validation and reliability in postal research. Pain (1997) 71: 141-7

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