Discussion
CDG
UTERINE CERVIX, DILATION
The main finding of the current study was an increase in the Obstetric students’ success rate in cervical dilation assessment when using the CDG, when compared to hard-consistency cervix simulation models.The accuracy of experienced midwives, nurses and physicians ranged from 49% to 58% in the simulation models When the groups were compared for each cervical dilation, a significant difference was found for 1.5 cm, 7.0 cm and 8.0 cm. Some authors report that, in medium dilations (5 cm-7 cm), accuracy decreases even among experienced professionals Sophisticated simulations such as high-technology or virtual reality models have been emphasized in the literature. However, low-fidelity simulations remain effective for students to learn how to perform a vaginal examination during delivery, as these models allow for a repetitive practice, in addition to being simple and accessible A research study on cervical assessment simulation training A number of studies recommend hard-consistency cervix manikin models to teach beginners As cervical alterations are not only limited to dilation, some authors Cervical assessment are useful to identify the evolution of dilation and when it is complete, it predicts delivery In this study, the CDG was developed as a low-cost and practical measuring tool that uses the diameter as a reference. It is simple, easy to use, affordable and requires no prior training.The key point of this tool is resorting to a visual objective measurement as a complement to finger proprioception. This learning process can be achieved with a simple ruler or measuring tape, which are widely available, easy to reproduce, versatile and cost-effective Other strategies have been used to improve this learning process. For example, the students measure the distance between the index and middle fingers to determine the actual width of that space In this study, direct visual comparison improved the students’ performance in cervical dilation assessment in the simulation models, with the possibility of being incorporated into laboratory training of labor, promoting a more careful teaching-learning process, as the students will be able to repeat their assessments as many times as necessary, minimizing repetitive vaginal touches in women to acquire this skill.This study is limited by the fact that the CDG was designed for direct visual comparison, thus only evaluating cervical dilation. Other important variables such as effacement, consistency and position were not included. The cervix simulation models and the CDG were tested for our needs; however, they have not been validated by experts. For greater accuracy of the assessments, the participants could have performed at least three assessments on each dilation model, comprising intra-rater reliability.From the results shown, statistically significant in the comparison of the correct assessment rate between the experimental and control groups (47.3% versus 27.2%), it can be stated that the direct visual comparison as an educational support tool is capable of assisting students in cervical dilation assessment in uterine cervix simulators. To the best of our knowledge, this is the first study to use visual comparison in addition to proprioception skills to train students in simulation models, which will certainly contribute to advancement of knowledge and of the clinical practice, as well as of patient safety in the Obstetrics area.