3B Scientific SIMone™ Birthing Simulator - Manual

Would you recommend the simulator to colleagues?
2
0
0
2
28
21
0 5 10 15 20 25 30
no answer
strongly disagree
disagree
neutral
agree
strongly agree
other
n=4; 7,5%
n=53
no answer
n=1; 1,9%
resident
(obstetrics/
gynecology)
n=13; 24%
internship
(obstetrics/
gynecology)
n=35; 65%
How do you assess the general quality of the simulator?
1
0
0
4
30
18
0 5 10 15 20 25 30 35
no answer
very bad
bad
neutral
good
very good
How is the degree of reality of the simulator?
6
0
4
5
26
12
0 5 10 15 20 25 30
no answer
very low
low
neutral
high
very high
How do you assess the accurracy of general anatomy of the
simulator?
1
1
11
12
23
5
0 5 10 15 20 25
no answer
very inaccurate
inaccurate
neutral
accurate
very accurate
The application of simulators in obstetrics/gynecology is useful?
1
1
1
2
8
40
0 5 10 15 20 25 30 35 40 45
no answer
strongly disagree
disagree
neutral
agree
strongly agree
Introduction
Very little is known regarding the value of birthing simulators in student
education, residency and postgraduate obstetric curriculum especially for
teaching operative vaginal delivery. The purpose of this paper is to vali-
date the use of a force and audio feedback birthing simulator SIMone™
(3B Scientifi c GmbH, Hamburg Germany). A questionnaire based survey is
performed to ascertain the opinion of obstetricians and gynaecologists on
this topical issue. By means of the survey, expert’s experience, motivations
and possible barriers to simulation based education in obstetrics are ta-
ken into account. We present the fi rst results that will provide evidence
and that will underline the use of birthing simulators and therefore opti-
mize clinical hands-on training.
Methods and Tools
The delivery simulator SIMone™ [1] is a model of a female abdomen with
a vulva and the Spinae ischiadicae as landmarks. Inside the model there is
a foetal head with a sagittal suture and fontanelle for determining the po-
sition and approach of the head (Figure 1).
A touchscreen (Figure 2) shows a corresponding image of the fetal head’s
positioning and rotation within the pelvis. By means of various scenarios
different birthing processes can be simulated. CTG, partogram and docu-
mentations (results, anamnesis) are presented as well as possible interven-
tions, i.e. vacuum extraction (Figure 3) and forceps extraction (Figure 4).
The monitoring software provides information in response to the manipu-
lation of the foetal head in the context of force-feedback. The speed and
resistance shown during pulling correspond with a real situation.
During the different delivery scenarios, the user of the simulator assesses
the course of the delivery and considers all the necessary measures, such
as the recognising the correct moment for a forceps delivery.
The simulation also supports audio aspects. A loudspeaker emits the foe-
tal heartbeat of the CTG device, as well as the respiratory sounds and ex-
perience of pain of the “mother” as a consequence of the delivery and the
actions of the person assisting in the delivery respectively.
A questionnaire based survey of experiences, perceptions, motivations
and perceived attitude to simulation-based education in instrumental de-
livery was designed and distributed to interns, obstetricians and gynaeco-
logists attending a hands- on workshop (Perinatalsymposium, November
16
th - November 18 th 2007, Universitätsklinikum für Frauenheilkunde und
Geburtshilfe, Medizinische Privatuniversität Salzburg, Austria) and a con-
ference (23
th German Conference of Perinatal Medicine, November 29 th –
December 1 st 2007, ICC Berlin, Germany). Our expert assessment survey
uses a 5 -point Likert-scale [2] (1, strongly disagree; 3, neutral; 5, strongly
agree) for scoring different items. More than other aspects were anatomic-
al and clinical fi delity, i.e. transvaginal examination of fetal head station
Figure 1:
the delivery simulator SIMone™
Results
The questionnaire based assessment involved a total number of partici-
pants of n=53, which consisted of n=35 (65%) interns and n=13 (24%)
residents in obstetrics/gynaecology (Figure 5). On average during their
career, the participants performed 1128,25 assistances with a normal
delivery (std.dev.: 3134,71), 240, 02 caesarean section (std.dev.: 752,11)
and 74,78 vacuum extractions (std.dev.: 167,35). The average number of
performed forceps deliveries was comparatively low at 52,75 interven-
tions (std.dev.: 189,62) (Figure 6). Over 2/3 of all participants strongly
agreed, that simulators in obstetric training in general were useful. Only
two participants disagreed or strongly disagreed (Figure 7).
In most cases the general anatomical accuracy was considered as either
very accurate or accurate (Figure 8). A very high or high degree of reality
of the simulator SIMone™ was reported by 39 participants (83, 0%) of our
survey (Figure 9). The overall assessment of the quality of the simulator
SIMone™ in 93, 3 % was considered as very good or good. There was no
negative statement concerning this item (Figure 10).
Finally 96, 1% of all participants would recommend the SIMone™ to
colleagues (Figure 11).
were considered as relevant scoring parameters (1, very unrealistic;
3, neutral; 5, very realistic). Statistics were performed using SPSS software
version 15 (SPSS, Chicago, IL).
Conclusion
The measurement of opinions is described as reliable and reproducible as
other biometric techniques [3]. Our validation study strongly suggests,
that simulators in medical education have utility in obstetrics and gynae-
cology. The results show, that SIMone™ is able to perform realistic and in-
teractive simulations of forceps delivery, vacuum extraction as well as nor-
mal delivery.
According to the participants’s assessments there is a good accuracy of
anatomical conditions. Furthermore the simulator SIMone™ provides an
opportunity to simulate birth scenarios and complications so that the trai-
nee can practice more frequently than they would be able to do with sel-
dom real clinical situations
Literature
[1] Obst T, Burgkart R, Ruckhäberle E, Riener R: The delivery-simulator: a new application
for medical VR. Stud. Health Technol. Inform (2004) 98:281-7
[2] Likert R: Rensis Liket on managing human assets. Bull Train (1978), 3:1-4
[3] Smith BH, Penny KI, Purves C, et al.: The chronic Pain grade questionnaire: Validation
and reliability in postal research. Pain (1997) 71: 141-7
Figure 2:
screen capture showing cardiotocogram, partogram and fetal head’s positioning
Figure 3:
vacuum extraction
Figure 4:
forceps delivery
Figure 5:
medical qualifi cation of participants
Figure 6:
performed interventions during the career of participants
Figure 7:
assessment of the useful-
ness of the simulator
SIMone™
Figure 8:
assessment of accuracy of
general anatomy of the
simulator SIMone™
Figure 9:
assessment of degree of
reality of the simulator
SIMone™
Figure 10:
assessment of general
quality of the simulator
SIMone™
Figure 11:
tendency to recommend
the simulator SIMone™ to
colleagues
Expert assessment of an audio and force feedback birthing simulator:
a questionnaire based survey
Wulf J 1 *, Lüdemann C 1 , Burgkart R 2 , Obst T 2 , Riener R 3
1) 3B Scientifi c GmbH, Hamburg, Germany
2) TU München, Lehrstuhl für Orthopädie und Unfallchirurgie, Munich, Germany
3) ETH and University Zurich, Sensory-Motor Systems Lab, Zurich, Switzerland
* Corresponding author contact: Joerg.Wulf@3bscientifi c.com
Kopie von Poster_SIMone.indd 1 10.01.2008 14:05:40 Uhr