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An improvement in medical undergraduate education in Ecuador throught hands-on training in perinatal skills

Introduction: In Ecuador, newly medical doctors are obliged to do a compulsory rural year to provide services in all medical fields, with a strong emphasis in obstetrics. Maternal mortality ratio has been stabilized around 50 per 100,000 live births, with postpartum hemorrhage as the main cause. Although skills laboratories are now widely used and recommended for undergraduate clinical skills education, medical curricula in Ecuador have little experience using them. As a response to the high perinatal mortality in the country, the Universidad Técnica Particular de Loja (UTPL), in the southeastern part of Ecuador, started a project implementing skills lab training. Objective: The objective of the study was to assess the improvement of the performance in perinatal skills needed in the rural area in final year students after a short educational intervention based on skills lab training. Method: Two subsequent groups of fifth year students were assessed and compared during an Objective Structured Clinical Examination (OSCE). Group 1 consisted of 39 students and Group 2 consisted of 43 students. Both groups received perinatal lessons in regular master classes, the group 2 additionally received training in six perinatal skills in small groups during the semester in the skills lab. Univariate statistics (independent student's t-test or chi square test) was performed to compare basic characteristics in the two groups and to compare final grades after the intervention. A p-value <0.05 was considered statistically significant. Results: Passing students in the total OSCE rises from 11.1% to 42.7% (p<0.05) between the first and the second group. The three stations with “no passing participants” in the first group are: pelvic examination, episiotomy and repair, and postpartum hemorrhage management. The global score for each skill showed an improvement except for Neonatal resuscitation. Conclusion: The implementation of skills lab training facilitates the acquisition and maintenance of perinatal skills. Curriculum changes are needed to improve the student’s competence. A skills laboratory provides a space to develop their skills and to receive an objective assessment.

Author(s): Galo Sánchez del Hierro, Roy Remmen, Veronique Verhoeven, Paul Van Royen, Kristin Hendrickx