Development and evaluation of cesarean section surgical training using computer-enhanced visual learning

Background: Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries. Methods: An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year residents used CEVL Cesarean and were evaluated intra-operatively by trained raters, then provided feedback about surgical performance. Clinical outcomes were collected for approximately 50 cesarean deliveries for each resident. Results: From 2010 to 2011, 12 first-year residents participated in the study. About 406 unique observed cesarean deliveries were analyzed. Procedures up to each resident's 70th case were analyzed by grouping cases in 10 s (cases 1-10 and 11-20), or deciles. Resident performance significantly improved by decile [chi(2)(6) = 47.56, p<0.001]. When examining each resident's performance, surgical skill acquisition plateaued by cases 21-30. Procedural performance, independent of resident, also improved significantly by decile [chi(2) (6) = 186.95, p<0.001], plateauing by decile 4 (cases 31-40). Throughout the observation period, operative time decreased by 3.84 min (p = 0.006). Conclusions: Pre-clinical teaching using computer-based modules for cesarean sections is feasible to develop. Novice surgeons required at least 30 procedures before performing the procedure competently. When residents performed competently, operative time and complications decreased.