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. 2023 Jul 7:3:1199194.
doi: 10.3389/fruro.2023.1199194. eCollection 2023.

CIRCumcision learning experience using simulation: A pilot learning platform for safe neonatal circumcision training offered either virtually or in person

Joana Dos Santos  1 , Abdulrahman Alsabban  1   2 , Max Maizels  3 , Michael Chua  1   4 , Sunayna Vuppal  1 , Emily Louca  1 , Martin Perlmutar  5 , Jennifer Knabl  1 , Mandy Rickard  1 , Abby Varghese  1 , Armando J Lorenzo  1 , Martin Allan Koyle  1
Affiliations

CIRCumcision learning experience using simulation: A pilot learning platform for safe neonatal circumcision training offered either virtually or in person

Joana Dos Santos et al. Front Urol. .

Abstract

Background: To our knowledge, no formal training combining didactic learning, simulation, and hands-on performance is available for practitioners performing neonatal circumcision. The absence of structured training may result in avoidable complications such as bleeding and penile injury. Herein, we present the results of a pilot neonatal circumcision training platform, offered either virtually or in person.

Material and methods: CIRCLES (CIRCumcision Learning Experience using Simulation) consist of 1. online didactic learning; 2. live simulation practice (in person or virtual coaching), and 3. clinical performance. Outcome measures included pre- and post-knowledge scores, self-efficacy questionnaires, and skill assessments of simulation and clinical performance (Likert rating). Face validity for training success was determined by an 80% passing score on the knowledge test and > 75% (mostly independent) performance.

Results: For this pilot, we restricted enrolment to seven pediatric residents and one nurse practitioner. Wilcoxon Sum Rank test for non-parametric paired samples for pre-and post-knowledge tests showed a median increase of 20 points in post-knowledge tests (p=0.011). Upon completion of the simulation training, all participants (8/8) have chosen to perform circumcision with the GOMCO clamp. Both in-person (4/4) and virtual participants (4/4) performed >75% of simulation and clinical circumcision independently. Post-training self-efficacy Z scores were higher than pre-training scores, except for the management of bleeding.

Conclusion: The pilot CIRCLES learning shows face validity for both in-person and virtual training for neonatal circumcision. We plan to extend this platform to include more trainees and to offer them to established practitioners. The availability of formal training may ultimately reduce adverse outcomes.

Keywords: circumcision training; education; neonatal circumcision; newborn; safe; virtual learning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors MK, AL, MR declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
3D printed silicone task trainer with base attached to a table. (A) Lateral view demonstrating penopubic crease and penoscrotal junction (for the teaching of anatomical landmarks and areas of insertion of the needle for the ring penile block). (B) Ventral view demonstrating coronal edge and frenulum. An opening was designed horizontally through each base so that the task trainer could be secured to the table using tape. To provide greater stability, an arm was designed, 3D printed, and fixed to the bottom of the trainer to extend outward from the base. (C) 3D printed model with a balloon sleeve cut to the size of the silicone trainer. A hole was cut at one end to simulate the foreskin accurately.
Figure 2
Figure 2
Wilcoxon Sum Rank test for pre- and post-knowledge test scores showing significantly higher scores post-training (p 0.011).
Figure 3
Figure 3
Forest plot chart comparing self-efficacy assessment of participants in all domains of confidence in neonatal circumcision pre- and post-CIRCLES.
Figure 4
Figure 4
Simulation-Based Training In-Person (PRACTICE).
Figure 5
Figure 5
Simulation-Based Virtual Training (Practice).
Figure 6
Figure 6
Clinical Performance with Urology Faculty Supervision (DO).
See this image and copyright information in PMC

References

    1. American Academy of Pediatrics: Circumcision Policy Statement . Task force on circumcision. Pediatrics (2012) 130(3):585–6. doi: 10.1542/peds.2012-1989 - DOI - PubMed
    1. Kim J, Koyle M, Dos Santos J. Assessment of risk factors for surgical complications in neonatal circumcision clinic. Can Urol Assoc J (2019) 13(4):E108–12. doi: 10.5489/cuaj.5460 - DOI - PMC - PubMed
    1. Koyle M. The fate of the foreskin. Can Urol Assoc J (2018) 12(2):29. doi: 10.1136/bmj.2.4642.1433 - DOI - PMC - PubMed
    1. DeMaria J, Abdulla A, Braga LH. Are physicians performing neonatal circumcisions well-trained? Can Urol Assoc J (2013) 7(7-8):260–4. doi: 10.5489/cuaj.200 - DOI - PMC - PubMed
    1. Sorokan T, Finlay J, Jefferies A. Newborn male circumcision. Paediatr Child Health (2015) 20(6):311–15. doi: 10.1093/pch/20.6.311 - DOI - PMC - PubMed

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