Development and evaluation of cesarean section surgical training using computer-enhanced visual learning

Abstract

Background: Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries.

Methods: An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year residents used CEVL Cesarean and were evaluated intra-operatively by trained raters, then provided feedback about surgical performance. Clinical outcomes were collected for approximately 50 cesarean deliveries for each resident.

Results: From 2010 to 2011, 12 first-year residents participated in the study. About 406 unique observed cesarean deliveries were analyzed. Procedures up to each resident’s 70th case were analyzed by grouping cases in 10 s (cases 1–10 and 11–20), or deciles. Resident performance significantly improved by decile [χ²(6) = 47.56, p < 0.001]. When examining each resident’s performance, surgical skill acquisition plateaued by cases 21–30. Procedural performance, independent of resident, also improved significantly by decile [χ²(6) = 186.95, p < 0.001], plateauing by decile 4 (cases 31–40). Throughout the observation period, operative time decreased by 3.84 min (p = 0.006).

Conclusions: Pre-clinical teaching using computer-based modules for cesarean sections is feasible to develop. Novice surgeons required at least 30 procedures before performing the procedure competently. When residents performed competently, operative time and complications decreased.

Acknowledgements

The authors would like to thank the Northwestern Memorial Foundation for its support of this project and Melissa Keene, M.D., and Kate Swanson from Northwestern University Feinberg School of Medicine for their assistance in data collection.

Declaration of interest: Dr Maizels is the Executive Director and co-owner of CEVL for Healthcare, Inc., a for-profit company established in June 2012. The CEVL web-based platform was used in this study, at which time it was an operating unit of Children’s Surgical Foundation, Inc., the non-profit operating unit of Ann and Robert H. Lurie Children’s Hospital in Chicago, IL (then Children’s Memorial Hospital). Ms. Stoltz is the Project Coordinator and Medical Illustrator at CEVL for Healthcare, Inc. Financial support for this study was provided by The Alvin H. Baum Family Foundation Clinical Simulation Research Grant, through the Northwestern Memorial Foundation. Dr. McGaghie’s contribution to this report was supported in part by the Jacob R. Suker, M.D., professorship in medical education at Northwestern University Feinberg School of Medicine and by grant number UL 1 RR025741 from the National Center for Research Resources, National Institutes of Health (NIH). The NIH had no role in the preparation, revision or approval of the manuscript. Drs. York, Jamil, McGaghie, and Gossett and Ms. Cohen report no declarations of interest.

Notes

*A portion of this article was presented as a poster 9–12 March 2011, at the 2011 Annual Meeting of the Association of Professors of Gynecology and Obstetrics and Council on Resident Education in Obstetrics and Gynecology. Research was conducted at Northwestern University Feinberg School of Medicine, Chicago, IL.