(968) Simulation Training to Improve Dilation and Evacuation Counseling in a Restrictive State

Objective: Following restrictive abortion legislation in Texas, OB/GYN residents have reduced exposure to Dilation and Evacuation (D&E). To address this training gap, a simulation and quality improvement initiative was implemented to increase resident familiarity with D&E and improve options counseling for patients with intrauterine fetal demise (IUFD).

Study Design: Residents at a single teaching institution participated in a monthly simulation activity, that included a pre-assessment of perceived barriers to D&E, a didactic video reviewing perioperative considerations and D&E steps, and a case-guided D&E simulation on a low-fidelity uterine model. The rate of complete options counseling (D&E vs medical induction) documented by residents in the electronic medical record and rate of D&E performed for patients with 2nd trimester IUFD (< 22 weeks gestation) was assessed before (9/2023-12/2023) and after (3/2024-6/2024) simulation implementation. Statistical significance was assessed via chi-squared test.

Results: 42 residents participated in the activity. On pre-assessment, most residents (76%) reported “rarely” or “never” discussing D&E with patients. “I do not know how to perform a D&E,” “I do not have available staff to supervise me during D&E,” and “I do not know how to counsel patients regarding D&E” were the most perceived barriers to D&E, identified by 71%, 67%, and 50% of residents respectively. In the pre-simulation period, 9/19 (47%) patients with IUFD had complete options counseling, and 3/9 (33%) elected for D&E. In the post-implementation period, 24/26 (92%, p=0.001) had complete options counseling and 8/24 (33%) chose D&E.

Conclusion: Documentation of complete options counseling was significantly improved after initiative implementation. Despite perceived barriers to D&E, residents counseled patients more consistently and performed more D&Es after simulation training. Rate of patient desire for D&E was unchanged. Low-fidelity D&E simulation may be an effective quality improvement initiative to address resident education gaps and improve options counseling for patients that are candidates for D&E.