Medical student simulation training in intrauterine contraception insertion and removal: an intervention to improve comfort, skill, and attitudes

Deborah Bartz, Amy Paris, Rie Maurer, Roxane Gardner, Natasha Johnson

Opportunities for medical students to place intrauterine contraception (IUC) in patients are rare. Our objective was to determine whether participation in an IUC insertion and removal simulation exercise would increase medical students' comfort level with, attitudes towards, and willingness to recommend IUC. A prospective cohort study was undertaken in all students completing the obstetrics and gynecology clerkship at a major academic hospital during the 2010-2011 academic year. The exposure consisted of a 45-minute interactive didactic session and a 30-minute, hands-on practicum in IUC placement and removal using medical instruments and realistic pelvic models. Both levonorgestrel and Cu380A IUC devices were utilized. Participants completed a pre- and post-simulation survey instrument, designed to examine students' IUC-specific knowledge, comfort, and attitudes. Pre- and post-simulation responses were compared by McNemar's test for paired samples. Thirty-five paired pre- and post-simulation surveys were analyzed, representing a 78 % response rate. Composite IUC-related knowledge scores increased by a median of 3 out of 10 points after the intervention (p < 0.01). Students were significantly more comfortable counseling patients about IUC as well as inserting IUC after the intervention, compared to before. Seven (20 %) students before, compared to 27 (77 %) after, agreed with the statement, "I feel comfortable placing an IUC in a patient under the supervision of an experienced doctor" (p < 0.01). Students developed significantly more favorable attitudes towards IUC through the intervention. Nineteen (54 %) participants before, compared to 27 (77 %) after, agreed with the statement, "I would recommend an IUC to my family member" (p = 0.02). A hands-on simulation during the obstetrics and gynecology clerkship increased medical students' knowledge of and comfort with IUC and resulted in more favorable attitudes toward the method. Intrauterine contraception simulation in medical curricula may help expand utilization of this effective contraceptive method.