Randomised comparison of theoretical versus hands-on training of vaginal operative delivery by vacuum extraction using Objective Structured Assessment of Technical Skills (OSATS)

Objective: To compare vaginal operative delivery by vacuum extraction (VE) after hands-on training vs. expert video demonstration.

Material and Methods: We randomized medical students to a 30 min expert demonstration (group one) or a 30 min hands-on (group two) training using a standardized VE algorithm on a pelvic training model. Students were tested with a 40 item Objective Structured Assessment of Technical Skills (OSATS) scoring system after training and four days later. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were secondary outcomes. We assessed the constructive validity of OSATS in this VE model comparing metric scores of experts and students. Statistics were performed using Mann-Whitney U-test, chi-square test, and multiple linear regression analysis.

Results: 137 students were randomized between May 2015 and October 2015. OSATS scores were higher in group two (n = 63) compared to group one (n = 74) (32.89 ± 6.39 vs. 27.51 ± 10.27, respectively; p < 0.0001). GRS (1.49 ± 0.76 vs. 2.33 ± 0.94, respectively; p < 0.0001), CON (2.22 ± 0.75 vs. 3.26 ± 0.94, respectively; p = 0.04), SA (2.03 ± 0.62 vs. 2.51 ± 0.77, respectively; p < 0.0001), and PT (38.81 ± 11.58 seconds vs. 47.23 ± 17.35 seconds, respectively; p = 0.001) also favored group two. After four days, this effect persisted with OSATS score still being significantly higher in group two (30.00 ± 6.50 vs. 25.59 ± 6.09, respectively; p = 0.001). The assessed OSATS scores showed constructive validity.

Conclusions: Hands-on training is superior to expert video demonstration for teaching VE on a pelvic model.