Immediately before the workshop, the racquetball “cervix and uterus” was placed into the PVC vagina through the model's posterior access, then the cap was replaced (Fig. 7). The PVC vagina allowed the placement of the speculum through which all procedures were performed. Firstly, workshop attendees removed the “cervical polyp” with ring forceps. Secondly, the IUD was removed, followed by the simulated cervical cancer screening collection. Lastly, a tenaculum was placed into the racquetball's anterior “cervical lip,” followed by inserting an endometrial sampling device to obtain the gelatin “endometrial tissue.” After the workshop, the gelatin was squeezed out of the uterus through the cervical os. The model was rinsed with tap water to allow reuse of the device in future workshops.
All workshop attendees were attending a larger 3-day skills workshop in which the gynecologic procedures skills was one of the multiple specialty options based on conference attendees' choice. Attendees received a 3-hour PowerPoint lecture with clear learning objectives.12,16 An expert women's health clinician with extensive experience in health care education developed and delivered the learning objectives and lecture. All workshop instructors were expert women's health clinicians. In the didactic portion, attendees were given evidence-based indications and instructions for the procedures, as well as clinical pearls. Attendee to instructor ratio was 8:1.16 After the didactic portion for each procedure, simulation of the procedure ensued. Attendees worked in pairs, each in turn completing the simulation with the instructors offering insight and help (Fig. 8). Attendees shared a vaginal model, but each had their own simulated uterus/cervix. They were afforded multiple opportunities to practice the simulated procedures.
The study received exempt status from Robert Morris University's institutional review board. Workshop attendees were recruited to participate in the study. After obtaining informed consent, study participants completed The National League for Nursing's (NLN) Student Satisfaction and Self-Confidence in Learning Tool18 at the conclusion of the workshop. The NLN's Student Satisfaction and Self-Confidence in Learning Tool is a 13-item instrument designed to measure student satisfaction (five items) with the simulation activity and self-confidence in learning (eight items) using a five-point scale. Reliability was tested using Cronbach α: satisfaction, 0.94; self-confidence, 0.87. In addition, the researchers obtained participants' demographics as to be able to describe the sample. To encourage participation, we randomly awarded US $50.00 gift cards to two study participants.
The researchers performed all calculations and statistical analysis using SPSS data-analytic software Version 22. Descriptive statistical analysis of the participants' demographics was calculated, as well mean scores and standard deviation of the tool results.
All participants were practicing advanced practice clinicians or students (Table 1). All workshop attendees (N = 30, 100%) completed the NLN's Student Satisfaction and Self-Confidence in Learning simulation questionnaire.18 The participants' average age was 37.9 years and all were female. All (N = 30, 100%) of the participants agreed at the “agree” or “strongly agree” level that the model was an enjoyable, helpful, motivating, and effective method to learn. Moreover, all (N = 30, 100%) of the participants agreed at the “agree” or “strongly agree” level that the simulation workshop built confidence. Similarly, all (N = 30, 100%) of the participants agreed at the “agree” or “strongly agree” level built confidence in mastery of skills and obtained the required knowledge to perform the procedures in a clinical setting. Almost all (n = 29, 97%) of the participants agreed at the “agree” or “strongly agree” level that they knew how to obtain help with concepts they did not understand as a result of the simulation. In addition, all (N = 30,100%) of the participants agreed at the “agree” or “strongly agree” level that it was their own responsibility to learn what they needed to know from the simulation activity. Finally, all (N = 30, 100%) of the participants agreed at the “agree” or “strongly agree” level that the simulation model was a helpful resource to learn gynecologic procedural skills.
Limitations of the study included a large number of advanced practice student participants who have limited clinical experience. The researchers envisioned all potential participants as experienced advanced practice clinicians looking to introduce new skills into their existing practice. Advanced practice students may be too inexperienced to know whether the simulation workshop would lead to increased confidence in actual performance of the simulated procedures on real patients. Furthermore, advanced practice students may not have the opportunity to perform the newly acquired skills on real patients. Another limitation for consideration was collecting self-reported data. The participants may have answered survey questions in a manner deemed more desirable or acceptable to the researchers. In addition, the sample size was small and limited to one workshop venue, which limits generalizability of the findings. Finally, the participants reported satisfaction with the workshop and increased confidence in skill acquirement; however, actual learning was not measured.
The purposes of this article are to provide information about a simulation model to teach routine gynecologic skills and to demonstrate participant satisfaction with a workshop teaching methodology. In agreement with previous studies,2,5,8,11–13 we found our low-cost and reusable model to be a valuable tool in introducing and teaching common skills in a workshop setting. High-fidelity and commercially produced static models are expensive, less accessible, and impractical for larger groups of learners, making the development of low-cost models an emerging trend in medical education.19 As acknowledged in previous model simulation research,5 there is some sacrifice of realism when not using a real patient. Despite the lack of realism, models such as ours offer numerous benefits. The model is reusable, portable, and cost-effective. Our gynecologic skills workshop combines auditory, visual, and kinesthetic learning that serves all types of learners.5 In a healthcare environment increasingly focused on providing safe care and improving patient satisfaction, our simulation model used in a workshop setting provides a practical venue for skill acquisition before real clinical practice. In simulation, learners can make mistakes without the worry of harming a real patient. Furthermore, unlike performing procedures on real patients, clinicians can repeat the procedure multiple times.
The survey results offered a greater depth and understanding of the participants' perceptions of the training. In agreement with previous findings,5,10 our results support the use of gynecologic models to provide a satisfying and confidence-building experience. In our study, the participants' perceptions of the simulation workshop were overwhelmingly positive.
In agreement with previous research,5,19 our simulated model represents versatility of use. We believe that our simulated model may be used to teach routine gynecologic procedures to other healthcare professionals, such as medical students, resident physicians, practicing physicians, and advanced practice students. The simulated PVC pipe vaginal model and racquetball uterus and cervix appear to be a useful model because they are reusable, cost-effective, durable, easy to assemble, clean, and store.
Simulation removes training from the clinical environment and provides a safe environment to practice skills with immediate instructor feedback.16 Simulation allows practicing clinicians the opportunity to learn new skills to facilitate integration into clinical practice. Despite the acknowledged limitations, our study demonstrates simulation as a satisfying, realistic, and confidence-building method for educating practicing clinicians in performing common gynecologic procedures. Furthermore, simulation gives healthcare educators the tools to properly instruct clinicians without needing to use costly and sparsely available high-fidelity or static gynecologic mannequins. This innovative model may also be used in formal healthcare educational programs for gynecologic procedure instruction. We suggest further studies to objectively measure whether learning outcomes were met.
The authors wish to extend a sincere thank you to the Regional Research and Innovation in Simulation Education (RISE) Center at Robert Morris University and Practitioner Education Associates, LLC for support of our work.
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Keywords:© 2017 Society for Simulation in Healthcare
Simulation; Gynecology; Women's health; Continuing education; Advanced practice; Procedures