1.1.12 Abortion: Before and After




Wednesday, November 13, 2013


Sloane York, Rush University Medical Center
Lori Gawron, Northwestern University
Jessica Kiley, Northwestern University
Ellen Lorange, Northwestern University
William McGaghie, Loyola University Chicago Stritch School of Medicine
Cassing Hammond, Northwestern University Feinberg School of Medicine

Title of Abstract/ Titre:

Training second trimester abortion providers: examining dilation and evacuation simulation-based education

Abstract Type / Type de résumé:

Program/Best Practices Abstract

Topic / Sujet:

Family planning practice

Significance/background / Importance/contexte:


Dilation and Evacuation (D&E) accounts for more than 90% of second trimester terminations in the United States due to patient preference and the procedure’s well-established safety profile with skilled providers. D&E are more cost-effective when compared to second trimester labor induction, often freeing the multiple resources needed for labor induction, and offers patients the advantage of a scheduled surgical procedure.

In the U.S. and abroad, many women lack access to D&E because few physicians are skilled in the procedure.  It is often difficult to train providers and maintain skills in low volume settings.  Simulation-based medical education is increasingly used to train novices in procedures.  Using simulation training increases competence prior to entering an operating room, improves patient outcomes, and reduces health care costs.

Simulation-based D&E training might decrease learning time for novice surgeons and help seasoned providers maintain skills.  It could also help introduce D&E into low resource settings throughout the developing world. 

Program intervention/activity tested:

Biomedical engineers and Family Planning Subspecialists at Northwestern University developed a high fidelity, low-cost D&E simulation model. First, this study assessed resident training using the model in a simulation laboratory setting.  Then the model was used to train residents using mastery learning prior to the resident’s family planning rotation and then the residents were directly observed intra-operatively to evaluate their performance of D&Es at 16 weeks or beyond gestational age.  

Methodology / Méthodologie:


Obstetrics and Gynecology resident physicians performed 6 “cases” on the model in the simulation laboratory.  Procedural time and total checklist scores were collected and then assessed using repeated measures ANOVA.  Over one year, third-year residents were trained to using mastery learning techniques on the simulator.  The resident’s performance in the operating room was directly observed and evaluated using multiple tools including a procedural checklist, a skills assessment, and procedural time by senior surgeons.

Results/key findings / Résultats/conclusions principales:


Twenty-four residents participated in the training assessment.  Cases were evaluated in pairs (1 and 2, 3 and 4, and 5 and 6) with significant differences in total scores between the three data points made up of two cases each (F(2,40) = 13.80, P = .000). Residents scored significantly higher on the combined fifth and sixth cases than previous cases.  Procedure time decreased over cases (F(2,40) = 7.12, P = .002).  Clinical data collection is currently ongoing.

Program implications/lessons / Implications pour le programme/leçons:


A high fidelity, low-cost simulation tool facilitates D&E training among novice providers. Implementing such a program is feasible in a U.S.-based training environment but could help clinicians around the world where D&E training is less frequent.  Clinicians may be able to use the model to initiate D&E services in areas where these services are not currently offered, which may improve patient safety and promote better resource allocation for patients requiring second trimester uterine evacuation. 


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