Randomized trial of high- and low-fidelity simulation to teach intrauterine contraception placement.


BACKGROUND High fidelity simulation creates conditions that resemble real circumstances, and can help teach procedures such as intrauterine contraception placement. Its impact on skill retention has not been studied. OBJECTIVE To evaluate novice learners' skills, attitudes, and knowledge on placement of intrauterine contraception when trained using a high-fidelity commercially available simulator compared with a low-fidelity simulator. STUDY DESIGN We recruited senior nurse practitioner students and interns in obstetrics and gynecology and family medicine inexperienced with intrauterine contraception placement. In this un-blinded, randomized controlled trial, participants were assigned to practice on a high-fidelity simulator group or a coaster-like model group. We evaluated intrauterine contraception placement skills, self-perceived comfort and competence, and knowledge before and after simulation, as well as at three months. Our primary outcome was the change in scores for intrauterine contraception placement skills before and after practice. Assuming a standard deviation of 15 points, we needed 10 participants per group to detect a 20-point difference in scores with 80% power. RESULTS From June to July 2014, 60 participants enrolled; 59 completed the initial study visit and one withdrew. Forty-eight (80%) completed the second study visit at three months. Demographic characteristics were similar for the randomization groups. We observed an improvement in intrauterine contraception placement skills for both groups following practice on simulators (p<0.01); the proportion who improved was similar (20% for the high-fidelity simulator group and 15% for the coaster group, p=0.55). Increases in self-perceived comfort and competence with placing the copper T380A, levonorgestrel 52mg, and levonorgestrel 13.5mg devices were similar (all p ≥0.11). Knowledge assessment scores were comparable between the two groups post-simulation (73% for the high-fidelity simulator group and 80% for the coaster group, p=0.29) and at three months (87% for both groups, p=1.0). CONCLUSION Trainees' knowledge, intrauterine contraception placement skills, and self-perceived comfort and competence were comparable whether they used high or low-fidelity simulators.

DOI: 10.1016/j.ajog.2017.11.553

Cite this paper

@article{Nippita2017RandomizedTO, title={Randomized trial of high- and low-fidelity simulation to teach intrauterine contraception placement.}, author={Siripanth Nippita and Miriam J. Haviland and Sara F Voit and Judith Perez-Peralta and Michele R. Hacker and Maureen E Paul}, journal={American journal of obstetrics and gynecology}, year={2017} }