A Randomized Trial of Clustered Versus Spaced Simulation in Forceps Assisted Vaginal Deliveries

The rates of forceps assisted vaginal deliveries (FAVD) in management of the second stage of labor are decreasing. This decline is mirrored by fewer learning opportunities for resident trainees in obstetrics. Prior studies have demonstrated an increase in trainee skill and confidence in performing FAVD with simulation. The optimum timing and frequency of simulation sessions to improve retention of skill is currently unknown. We tested the effects of clustered versus spaced training sessions to teach trainees FAVD and hypothesized that spaced training sessions would lead to superior retention of skill. We used a commercially available pelvic trainer (Lucy's Mum, MODEL-med®) and measured objective structured assessment of technical skills (OSATS) scores at >1-month post-intervention. This was a randomized controlled trial of clustered versus spaced FAVD simulation sessions. Thirty-five (n=35) enrolled participants gave us 80% power to detect a difference of OSATS score of 6. Trainees and obstetric providers who do not independently perform FAVD were randomized in blocks to a single learning session (clustered/30 minutes of hands-on teaching with a model; n=17) or three individual learning sessions (spaced/10 minutes each x3; n=18) spaced one week apart. Participants completed an online module introducing FAVD and completed skillset questionnaires pre- and post- simulation. We used a chest-mounted GoPro™ camera to capture first person point-of-view technique in order to blind expert adjudicators to participants' identities and this blinded footage was used to grade average OSATS scores. Both clustered and spaced simulation training led to improved FAVD OSATS score post-intervention (+4.8 vs. +5.9 from baseline), however the median change was not different between randomization group (p = 0.78, Wilcoxon Rank Sum). Both simulation groups had higher confidence to apply forceps, perform safety checks, and independently/safely perform FAVD (p < 0.05, t test). We describe a novel use of point-of care video and simulator application to improve FAVD simulation training. OSATS scores and provider self-assessment of training improved regardless of clustered vs. spaced simulation sessions.