Development of evaluation grids for obstetrical techniques in simulation training using the Delphi method.

Abstract

Background: Simulation-based training has become a cornerstone in obstetrics education, offering valuable opportunities to practice rare and complex procedures in a controlled environment. The importance of simulation in obstetrics and gynecology is well documented internationally, particularly in improving clinical skills and patient safety.In some countries, certain obstetric procedures, such as vaginal breech delivery or shoulder dystocia management, are infrequently performed, which highlights the challenge of ensuring that practitioners are adequately prepared for these rare events. Research has shown that simulation can bridge this gap by providing a means to gain familiarity with procedures that may not be regularly encountered.

Objective: To develop and validate evaluation grids for these key obstetric maneuvers through the Delphi method to ensure a reproducible and reliable assessment tool for use in simulation-based education.

Methods: We employed the Delphi method to achieve consensus among a panel of 14 obstetric experts with extensive experience in simulation training. Three successive rounds of evaluation were conducted to assess the relevance of various criteria for the maneuvers in question: breech maneuvers, version and breech extraction, and shoulder dystocia maneuvers. Nine experts responded to the three rounds. A criterion was included in the final gird if it obtained a median score between 7 and 9 with 80% of the responses within this interval. A criterion was excluded if it obtained a median score between 1 and 3 with 80% of the responses in this interval. Criterion that were neither included nor excluded were submitted to the next round. At the end of the third round, the criterion was included if the median was between 7 and 9 over the three successive rounds, even if less than 80% of the responses were in this interval. In all other cases, the criterion was excluded at the end of the third round.

Results: In total, for breech maneuvers, five criteria for the preparatory maneuver, 11 criteria for the Lovset maneuver, five criteria for the Bracht maneuver, and eight criteria for the Mauriceau maneuver were included in our evaluation tool. For the version and breech extraction maneuver, four criteria concerning preparation and 13 criteria relative to the stages of the maneuver were included in our evaluation grid. Finally, for the shoulder dystocia maneuvers, five preparatory criteria, four criteria for the McRoberts maneuver, six criteria for the reverse Woods maneuver and nine criteria for the Jacquemier maneuver were included in the evaluation grid.

Conclusion: We successfully developed a set of evaluation grids for three critical obstetric maneuvers using the Delphi method, with input from experts. In future, these grids can be used to certify obstetrics residents during their curriculum, after being validated in a second study.