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Lord MG, Esposito MA, Gimovsky AC, Carr SR, Russo ML. A Low-Cost, High-Fidelity Simulator for Transabdominal Chorionic Villus Sampling. Fetal Diagn Ther 2023; 51:101-111. [PMID: 38081148 DOI: 10.1159/000534485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/26/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Chorionic villus sampling (CVS) remains essential for first-trimester genetic diagnosis, yet clinical volume may be insufficient to train new clinicians in the technique. Available simulation models are expensive, require animal parts or specialized resins, and cannot be stored for repeated use. METHODS We present a model for trans-abdominal CVS (TA-CVS) which is constructed from readily available materials costing less than $10 and can be refrigerated and re-used to train maternal-fetal medicine fellows in CVS. RESULTS All three attending physicians performing TA-CVS at our institution described the model as an accurate visual and tactile simulation, prompting its integration into our fellowship curriculum. To date, two senior fellows have achieved competency on the simulator and begun to perform clinical CVS under supervision, one of whom is an author on this paper. Both fellows and attendings indicated that the simulator provided a valuable tool for repeated practice prior to clinical CVS. Simulators are now maintained on the unit and have been re-used for 3 months and dozens of simulated procedures each without any apparent qualitative degradation in performance. DISCUSSION/CONCLUSION We describe a low-cost easily constructed, durable, high-fidelity simulator for TA-CVS.
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Affiliation(s)
- Megan G Lord
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Matthew A Esposito
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen R Carr
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Melissa L Russo
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Johnsson V, Tolsgaard MG, Petersen OBB, Svendsen MBS. Building low-cost simulators for invasive ultrasound-guided procedures using the V-model. Adv Simul (Lond) 2023; 8:14. [PMID: 37194088 DOI: 10.1186/s41077-023-00254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
The use of medical simulators for training technical and diagnostic skills has rapidly increased over the past decade. Yet, most available medical simulators have not been developed based on a structured evaluation of their intended uses but rather out of expected commercial value. Moreover, educators often struggle to access simulators because of cost or because no simulators have been developed for a particular procedure. In this report, we introduce "the V-model" as a conceptual framework to illustrate how simulator development can be guided by the intended uses in an iterative fashion. Applying a needs-based conceptual framework when developing simulators is important to increase the accessibility and sustainability of simulation-based medical education. It will minimize the developmental barriers and costs, while at the same time improving educational outcomes. Two new simulators for invasive ultrasound-guided procedures are used as examples, the chorionic villus sampling model and the ultrasound-guided aspiration trainer. Our conceptual framework and the use cases can serve as a template for future simulator development and documentation hereof.
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Affiliation(s)
- Vilma Johnsson
- Center for Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Martin Grønnebæk Tolsgaard
- Center for Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Copenhagen, Denmark
| | - Olav Bennike Bjørn Petersen
- Center for Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Copenhagen, Denmark
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Antony KM, Khurshid N, Trampe B, Gupta VK, Iruretagoyena JI, Stewart KS, Shah D. Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship. AJP Rep 2018; 8:e251-e260. [PMID: 30370179 PMCID: PMC6202070 DOI: 10.1055/s-0038-1675344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training. Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted. Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.
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Affiliation(s)
- Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nauman Khurshid
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, University of Toledo, Toledo, Toledo, Ohio
| | - Barbara Trampe
- Meriter Center for Perinatal Care, Meriter-UnityPoint Health, Madison, Wisconsin
| | - Vivek K Gupta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - J Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Katharina S Stewart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dinesh Shah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Bhutta SZ, Yasmin H. Comparative Effectiveness of Teaching Obstetrics and Gynaecological Procedural Skills on Patients versus Models: A randomized trial. Pak J Med Sci 2018; 34:794-798. [PMID: 30190730 PMCID: PMC6115552 DOI: 10.12669/pjms.344.15521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the effectiveness of learning procedural skills on patients versus mannequins and models. Methods: Seventy four interns from two consecutive batches at the Department of Obstetrics and Gynaecolgy Unit-I at Jinnah Postgraduate Medical Center Karachi participated in the study between April and September 2014. Five basic skills; taking a cervical (Pap) smear, intrauterine contraceptive device insertion, manual vacuum aspiration, making/ suturing an episiotomy and active management of the third stage of labour were identified. Interns were randomly allocated to two training groups (Group-1 and 2 of thirty eight and thirty six trainees respectively), with Group-I received training on the five procedural skills on models and mannequins for four weeks while Group-II trained on patients initially. After an evaluation at four weeks the groups crossed over with a final evaluation at eight weeks. The evaluation was through identical objective structured assessment of technical skills on models and mannequins for both groups with standard checklists. Results: There was no significant difference in skills between the two groups at the four weeks assessment. However at the end of training, Group-1 trainees performed significantly better than Group 2 with higher overall tests scores (86.7 ± 2.7 versus 80.4 ± 4.8, p< 0.001). This difference was more marked in skills of intrauterine contraceptive device insertion, making and suturing an episiotomy and active management of third stage of labour. Conclusion: Our findings suggest that simulations using models and mannequins for developing procedural skills can be readily incorporated in training programs with potential benefits for teaching infrequently performed or more difficult procedures. Our data suggest potential benefits of initiation of trainings on simulations and mannequins followed by human subject exposure.
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Affiliation(s)
- Shereen Zulfiqar Bhutta
- Prof. Shereen Zulfiqar Bhutta, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Haleema Yasmin
- Dr. Haleema Yasmin, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Suskin BG, Sciscione AM, Teigen N, Jenkins TC, Wapner RJ, Gregg AR, Gross SJ, Bajaj K. Revisiting the challenges of training Maternal Fetal Medicine fellows in chorionic villus sampling. Am J Obstet Gynecol 2016; 215:777.e1-777.e4. [PMID: 27530492 DOI: 10.1016/j.ajog.2016.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than a decade ago, researchers described a survey of Maternal Fetal Medicine fellows that showed that chorionic villus sampling training was limited for Maternal Fetal Medicine fellows in the United States. Prenatal screening and diagnosis have rapidly evolved since then and include the introduction of noninvasive aneuploidy screening that uses cell-free fetal DNA. Yet, chorionic villus sampling remains the only method available for first-trimester genetic diagnosis. OBJECTIVE This study evaluated the chorionic villus sampling training of Maternal Fetal Medicine fellows with respect to availability, competency standards, and education methods. STUDY DESIGN In November 2015, an electronic survey was sent to Maternal Fetal Medicine fellows and fellowship directors of accredited Maternal Fetal Medicine fellowship programs in the United States. RESULTS Fifty-eight percent of fellows (179/310) and 46% of program directors (35/76) responded. Ninety-five percent of Maternal Fetal Medicine fellows think that invasive diagnostic testing is essential to their training; 100% of fellows have amniocentesis training; and 65% have chorionic villus sampling training. The median number of chorionic villus sampling procedures that are expected during a fellowship in those who trained was 10. Eighty-eight percent of fellows and 89% of program directors state that chorionic villus sampling training could be better; 89% of fellows and 97% of directors would like access to simulated models. Barriers to training included lack of patients (71%) and lack of proficient attending supervisors (43%). CONCLUSION Since the last survey, >10 years ago, chorionic villus sampling training has declined further. A decrease in the number of procedures that are performed is the leading barrier to this training.
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Affiliation(s)
- Barrie G Suskin
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Anthony M Sciscione
- Christiana Care Health System, Maternal Fetal Medicine, Wilmington, Delaware
| | - Nickolas Teigen
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Thomas C Jenkins
- Kosair Children's Hospital-Maternal Fetal Medicine, Louisville, KY
| | - Ronald J Wapner
- Columbia University, Department of Maternal Fetal Medicine, New York, NY
| | - Anthony R Gregg
- Maternal-Fetal Medicine, University of Florida Obstetrics and Gynecology, Gainesville, FL
| | | | - Komal Bajaj
- Jacobi Medical Center, New York City Health + Hospitals, Bronx, NY.
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Sanhal CY, Mendilcioglu I, Ozekinci M, Simsek M, Bozkurt S. Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis: An alternative perspective on prenatal invasive techniques. Pak J Med Sci 2015; 31:1038-42. [PMID: 26648982 PMCID: PMC4641251 DOI: 10.12669/pjms.315.7477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC). METHODS Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II). RESULTS A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores. CONCLUSION We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.
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Affiliation(s)
- Cem Yasar Sanhal
- Cem Yasar Sanhal, MD. Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Inanc Mendilcioglu
- Inanc Mendilcioglu, Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Murat Ozekinci
- Murat Ozekinci, Assistant Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mehmet Simsek
- Mehmet Simsek, Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Selen Bozkurt
- Selen Bozkurt, Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine, Antalya, Turkey
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