Development of an Anatomical Silicone Model for Simulation-based Medical Training of Obstetric Anal Sphincter Injury Repair in Bangladesh
Bibliographic record
Abstract
Advancing global healthcare in developing countries has traditionally been an area of interest for many North American medical organizations, as they strive to improve patient outcomes by helping to control disease and death-related illnesses. Women's healthcare in developing countries, in particular, presents a unique set of complexities, revealing high maternal mortality statistics surrounding pregnancy, labor, and childbirth, which is often tied to home births without medically trained attendants. In September 2018, Team Broken Earth, a Canadian-based outreach initiative, hosted a three-day women's healthcare course in Dhaka, Bangladesh, which included simulation-based training stations, for the purpose of advancing clinical skills and education in regards to local labor and delivery. The training stations included the prevention of shoulder dystocia, helping babies breathe, the application of uterine compression sutures, and the repair of obstetric anal sphincter injuries (OASIS). The OASIS management station provided an opportunity to practice anal sphincter repair on anatomically accurate silicone models, which was a focus of the training course due to the high frequency of such injuries in rural Bangladesh. Evaluation surveys were supplied to workshop participants to capture their feedback about the use of the OASIS models and their efficacy as a training tool in Bangladesh. Overall, the models were considered superior as compared to pre-existing training methods, which traditionally involve textbook education and hands-on learning in emergency birthing scenarios by non-medically trained attendants. Two minor iterative improvements were suggested during the Team Broken Earth workshops in Dhaka, Bangladesh, with regards to improving the models for future use: (a) the ethnicity coloring of the models should be more inclusive, especially when delivering training in international countries, and (b) future silicone models should include the addition of mesh across the bottom layer to ensure participants fingers did not rupture the enclosed vaginal canal while suturing. The purpose of this technical report is to determine the efficacy of a silicone OASIS model, developed for practicing high-risk laceration repair that can occur during childbirth, which presents in higher frequency in developing countries, such as Bangladesh, due to the number of rural at-home deliveries. The original study in this series involved the investigation of silicone perineal repair models focusing on first- and second-degree lacerations, which were used at the Remote and Rural Conference in St. John's, Newfoundland, in April 2018. The facilitators distributed the first iteration of the models to conference participants and collected participant feedback, which concluded that several improvements were required to enhance the models for medical training purposes. With the iterative revisions complete, the model is now under further validation testing to determine its efficacy within simulation-based medical education (SBME) and clinical skill maintenance. This technical report is the second in the series and includes the most recent third and fourth-degree silicone models as well as all suggested improvements from previous clinical feedback.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".