Development and evaluation of an external cephalic version simulation-based educational program

Abstract

BACKGROUND

Fetal malpresentation contributes significantly to cesarean deliveries. External cephalic version (ECV) reduces this risk but requires skilled performance. In low-resource settings, limited training opportunities hinder its use, highlighting the need for effective simulation-based education.

OBJECTIVE

This study aimed to develop and evaluate an external cephalic version simulation-based educational program.

STUDY DESIGN

We used Kern’s 6-step framework to develop a program composed of 6 learning objectives with 6 distinct components specifically for low-resource settings. We conducted a 3-round modified Delphi panel to modify the program. We evaluated the program through a cluster randomized study of obstetrics and gynecology house officers, junior residents, senior residents/fellows, and consultants/attendings in January 2025 at Korle Bu Teaching Hospital in Ghana. Self-reported comfort and confidence, knowledge, skill, and program feasibility and acceptability were analyzed using t tests, Fisher exact tests, and Spearman’s rho.

RESULTS

The Delphi panel consisted of 14 experts from 5 countries. At least 80% consensus on all external cephalic version program components was reached before implementation. The learning group’s self-reported comfort and confidence (P<.01) and knowledge measured via assessment (P<.01) improved after the program compared with the preprogram period. The learning group’s skill measured via procedural checklist increased compared with the control group (P<.01). Within the learning group, self-reported comfort and confidence (P<.01) and skill in completing key steps on the procedural checklist (P=.02) were higher among those with a higher level of training. The participants were satisfied with the program and found it acceptable, appropriate, and feasible (5-point rating; mean, 4.42; standard deviation, 0.54).

CONCLUSION

Our external cephalic version simulation-based program improves comfort and confidence, knowledge, and skill among Ghanaian clinicians. Given that external cephalic version success depends on the skill of the performing clinician, our program may help increase external cephalic version rates and thus decrease the rates of avoidable cesarean delivery and its complications.