Strengthening Abortion Training: A Dilation and Evacuation Checklist in Military Resident Education.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-05 DOI:10.1093/milmed/usad491
Kiley Hunkler, Carissa Pekny, David Boedeker, Amanda Owens, Donald Wiersma, Sara Drayer
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Abstract

Introduction: A dilation and evacuation (D&E) is a safe and effective option for patients undergoing a second trimester abortion. Recent legislation and geographic restrictions threaten patients' access to this surgical procedure, prompting a call to action to strengthen abortion training. This quality improvement project aimed to assess if a standardized lecture and checklist would improve military trainee knowledge and comfort with performing D&Es.

Materials and methods: Using society recommendations and incorporating available level I to III evidence, a standardized checklist for D&Es was created to include necessary equipment, procedural steps, perioperative considerations, and potential complications. The checklist and associated lecture were presented to gynecology residents from seven of the nine military training programs. Residents completed a six-question assessment regarding comfort and knowledge in performing D&Es prior to and following the intervention. Responses were ranked on a five-point Likert scale and analyzed with the Wilcoxon sign-rank test. This project was deemed exempt by the Institutional Review Board. The standard Plan, Do, Study, Act (PDSA) methodology was used for ongoing assessment of the efficacy of this quality improvement project.

Results: There were 67 trainees that completed the pre-intervention assessment and 44 who completed it post-intervention, with 27 responses paired for statistical analysis. All trainees self-reported improved comfort and knowledge in all procedural aspects of D&Es, with the largest improvement observed in equipment knowledge (mean difference 1.44, P <0.001), performing procedural steps (mean difference 1.26, P <0.001), and managing complications (mean difference 1.33, P <0.001).

Conclusions: Use of an evidence-based checklist significantly improves resident knowledge and comfort with performing second trimester D&Es. In a post Dobbs environment, the military is an appropriate proxy for larger society and training programs need to develop alternatives and adjuncts to clinical training.

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加强人工流产培训:军事住院医师教育中的 "扩宫和排气检查表"。
简介扩张和排空术(D&E)是第二孕期人工流产患者的一种安全有效的选择。最近的立法和地域限制威胁到了患者接受这种手术的机会,因此呼吁采取行动加强人工流产培训。本质量改进项目旨在评估标准化讲座和核对表是否能提高军事受训人员对实施 D&E 的了解和舒适度:采用学会的建议并结合现有的 I 至 III 级证据,创建了一份 D&E(人工流产)标准化核对表,其中包括必要的设备、手术步骤、围手术期注意事项和潜在的并发症。九个军事培训项目中的七个项目向妇科住院医师介绍了该核对表和相关讲座。住院医师在干预前和干预后完成了一份由六个问题组成的评估,内容涉及进行 D&E 的舒适度和知识。评估结果采用李克特五点量表进行排序,并通过 Wilcoxon 符号秩检验进行分析。该项目被机构审查委员会视为豁免项目。标准的 "计划、实施、研究、行动(PDSA)"方法用于持续评估该质量改进项目的效果:共有 67 名学员完成了干预前的评估,44 名学员完成了干预后的评估,其中有 27 份答卷配对进行了统计分析。所有受训人员都自我报告说,他们在所有 D&E 程序方面的舒适度和知识水平都有所提高,其中设备知识方面的提高最大(平均差异为 1.44,P 结论:使用循证核对表能显著提高受训人员的舒适度和知识水平:使用循证核对表可显著提高住院医师对第二孕期产前检查的知识水平和操作舒适度。在后多布斯环境中,军队是大社会的适当代表,培训计划需要开发临床培训的替代品和辅助工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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