Impact of simulation training on success of vacuum-assisted vaginal delivery and external cephalic version in clinical practice: a randomized controlled trial.

BACKGROUND: We assessed the impact of simulation-based training for vacuum-assisted vaginal delivery (VD) and external cephalic version (ECV) on procedural success, complications, and learner experience in the delivery room. METHODS: We conducted a randomized controlled trial at Hôpitaux Universitaires de Genève between 2018 and 2022. Obstetrics residents with limited experience were randomized to receive simulation training in either VD or ECV, with each group serving as the control for the other procedure. Training involved standardized, low-fidelity simulation sessions delivered over six months, combined with supervised clinical practice. We prospectively recorded all clinical VD and ECV procedures performed during the study period. The primary outcome was procedural success, defined as completion without senior takeover. Secondary outcomes included complications, patients' perceptions of safety and pain, learners' confidence, and perceived difficulty. Analyses were performed on an intention-to-treat basis and adjusted for relevant clinical and operator factors. RESULTS: The study included 50 residents; 44 performed 583 VDs, and 46 performed 214 ECVs. Simulation training did not significantly improve success rates (VD: Odd Ratio (OR) 0.66, 95% CI 0.41-1.05; ECV: OR 1.30, 95% CI 0.70-2.40). Complication rates, perceptions of safety, pain, and difficulty were similar between groups. Clinical experience was associated with higher success rates (OR 1.05, 95% CI 1.01-1.08 per prior VD; OR 1.10, 95% CI 1.01-1.20 per prior ECV). CONCLUSION: The study was underpowered to determine whether simulation had a statistically significant effect on the success rates of VD or ECV. Clinical experience remains an important determinant of experiential learning.