DEVELOPMENT OF A DILATION AND EVACUATION SIMULATOR AND TRAINING CURRICULUM

Objectives

We aimed to develop a low-cost, low fidelity dilation and evacuation simulator and training program. We sought to increase resident exposure, skills, and confidence with dilation and evacuation in an abortion-restrictive state.

Methods

The dilation and evacuation simulator was based on previously designed and tested simulators. A basic learning module was developed. Providers experienced in dilation and evacuation tested the model to assess for accuracy of simulation. The simulator was incorporated into resident didactic time and pre- and post-tests assessed knowledge, skills, and confidence in dilation and evacuation.

Results

Participating residents were evenly split between PGY-1 or 2 (n=5) and PGY-3 or 4 (n=5) training levels. Residents demonstrated improvement in knowledge of dilation and evacuation with average pretest score of 73.2% and average post test score of 90%. Prior to simulation, 80% of residents reported they knew the steps of a dilation and evacuation but only 50% felt comfortable performing one with supervision. Experienced providers felt that the cervical dilation was either realistic or very realistic, and that the simulation of calvarium, placenta, and fetal parts was somewhat realistic or neither realistic nor unrealistic.

Conclusions

Low-cost simulation can provide a reasonably realistic simulation of dilation and evacuation. Simulation is an effective way to improve resident knowledge and comfort with this procedure. Strengths of this study include a cohort evenly split by training levels and by residents who trained before and after restrictive abortion laws were in place. Limitations include limited number of experienced providers for simulator testing and lack of assessment of resident comfort or skills after training on the simulator.