Simulation
Materials and Preparation
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- Fetal model:
- Clay-covered egg (calvarium)
- Dried pasta
- Pepperoni sticks (limbs)
- Mushroom (placenta)
- Other options are: cat toys, ping-pong balls, and nerf darts. Consider attaching the parts with Velcro.
- Pelvic model:
- Hollow melon
- 36-oz rice jar with foam can holder and felt fabric square
- 1 cm thick neoprene adhered to silicone cervix with Velcro
- Water bottle
- Optional cover to aid in tactile versus visual learning
- Ring forceps
- Extraction forceps
- Fetal model:
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The room should be set up as similarly as a procedure room if you are going to run through the entire scenario of speaking to or counseling the patient and then performing the task. If only the task is going to be done, then the setup would not be as significant.
- On a tray table, the following items should be set up:
- Ring forceps
- Extraction forceps
- Pelvic model on a table lined with paper or chux
- Chair or rolling stool for learner to sit on
- On a tray table, the following items should be set up:
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- Staff member to set up equipment
- Standardized patient if so desired
Tips
Answers to Common Questions
- Remember that this is a simulation. Nothing can be as exact as real life, but this is a close approximation.
- Reiterate that what is important is for the learner to go through the steps of the procedure from start to finish, so that they are more familiar with the steps when they actually do the procedure in the office
Lab Sequence
- Assemble all of the equipment as aforementioned
- Begin counseling the patient on all the risks, benefits, and alternatives
- Conduct a timeout
- Bimanual examination for size and position of uterus and assess cervical dilation and effacement
- Assess location of fetus using ultrasound examination or digital examination
- Grasp anterior lip of cervix with appropriate instrument
- Attempt to perform amniotomy
- Choose proper instrument for extraction
- Initiate extraction by introducing instrument and putting traction on anterior lip Introduce forceps closed
- Open widely when past internal cervical os
- Extract material carefully using appropriate technique
- Keep track of parts removed
- Confirm the uterus is empty
- Examine tissue removed to ensure all parts have been extracted
- Remove all instruments
Competency Assessment
The resident will be able to identify indications for second trimester dilation and evacuation (D&E) and be able to counsel the patient appropriately. The resident will be able to identify the equipment and supplies necessary. The resident will be able to demonstrate in a simulated environment the steps of a D&E.
Associated Content
The CREOG Surgical Skills Task Force created this simulation as part of a standardized surgical skills curriculum for use in training residents in obstetrics and gynecology.