Objective Structured Assessment of Technical Skills (OSATS) evaluation of theoretical versus hands-on training of vaginal breech delivery management: a randomized trial

Objective: To compare the skills of performing a vaginal breech (VB) delivery after hands-on training versus demonstration. Study design: We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on (group 2) training session using a standardized VB management algorithm on a pelvic training model. Subjects were tested with a 25 item Objective Structured Assessment of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes. Statistics were performed using the Mann-Whitney U-test, chi-square test, and multiple linear regression analysis. Results: 172 subjects were randomized. OSATS scores (primary outcome) were significantly higher in group 2 (n = 88) compared to group 1 (n = 84) (21.18 +/- 2.29 vs. 20.19 +/- 2.37, respectively; p = 0.006). The secondary outcomes GRS (10.31 +/- 2.28 vs. 9.17 +/- 2.21; p = 0.001), PT (214.60 +/- 57.97 s vs. 246.98 +/- 59.34 s; p < 0.0001), and CON (3.14 +/- 0.89 vs. 2.85 +/- 0.90; p = 0.04) were also significantly different between groups, favoring group 2. After 72 h, primary and secondary outcomes were not significantly different between groups. In a multiple linear regression analysis, group assignment (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.14-2.05; p < 0.0001) and gender (OR 2.91; 95% CI 2.45-3.38; p < 0.0001) independently influenced OSATS scores. Conclusion: Hands-on training leads to a significant improvement of VB management in a pelvic training model, but this effect was only seen in the short term. (C) 2013 Elsevier Ireland Ltd. All rights reserved.