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To evaluate the impact of introducing an amniocentesis simulation curriculum in the MFM fellowship training.
A new curriculum to teach amniocentesis was created in 2009 comprising of reading assignments, group discussion, and hands on simulation. This ecoflex silicon model resembles the maternal interface when interrogated by ultrasound waves. Versatility of the simulation model allows recreating real life situations by changing fetal positions and placental locations. During the simulation sessions the fellows learn both one hand (guided by sonographer) and two hands techniques (guiding themselves). Communication skills are also stressed upon. Real life amniocentesis are performed by the fellow once adequate skills are achieved. The course is completed in the first 6 months of fellowship. Amniocentesis performance of the fellows that received simulation training was compared with the fellows who did not receive the training. To evaluate objective differences, assessment included number of attempts per amniocentesis, bloody aspirate, transplacental needle entry, fetal injury, abruption and preterm premature rupture of membranes.
256 amniocentesis were performed by fellows. The simulation curriculum decreased the number of attempts by first and second year fellows to complete a procedure. In the pre-simulation training group (Figure 1), there were 12 events in which more than one attempt was made to complete the amniocentesis during the first year of training, 7 in second year and none in their third year. The post simulation training group had no second attempts in any training year. There were no differences in complications. Figure 2 shows decrease in amniocentesis procedures over the past 6 years. The numbers of amniocentesis performed by the fellows have remained stable.
The simulation training curriculum helps new fellows to gain experience earlier in their training in a stress free environment thereby avoiding practice trial on actual patients.