# Dilation and Evacuation Simulation Model for Learners and Providers Who Offer Abortion Care

## TL;DR

This paper introduces a low-cost, realistic simulation model for training medical professionals in dilation and evacuation (D&E) procedures for second-trimester abortions.

## Contribution

The novel contribution is a cost-effective and easily replicable D&E simulation model using accessible materials.

## Key findings

- Participants' comfort levels in performing D&Es increased significantly after the simulation.
- 92% of participants found the simulation realistic, and 100% reported increased knowledge.
- The model is proposed as a valuable training tool for providers with limited access to clinical abortion training.

## Abstract

In the US, one in four women will have an abortion, and most OB/GYN physicians have had patients who required abortion care. Most second-trimester abortions in the US (95%) are performed via dilation and evacuation (D&E), which requires provider skill and competency. Barriers to obtaining abortion training include opt-in residency programs, location-based legal restrictions, and religiously affiliated institutions. Our D&E simulation is a cost-effective, realistic model.

D&E models were assembled using juice containers, Cornish hens, and Sopher forceps. Thirty-five participants (medical students and OB/GYN residents) completed presimulation surveys and received a brief lecture about abortion demographics, techniques, and complications, followed by the hands-on simulation; 27 completed postsimulation surveys. Participants assessed their comfort levels in performing D&Es and recognizing postabortion complications, and their likelihood of performing D&Es in future clinical practice.

Comfort levels significantly improved pre- to postsimulation, increasing from 32% to 55% (p < .001) for participants reporting feeling somewhat comfortable or extremely comfortable performing D&Es, and increasing from 46% to 63% (p < .01) for participants reporting feeling somewhat comfortable or extremely comfortable recognizing postabortion complications after receiving the introductory lecture. Overall, participants indicated that the simulation was realistic (92%) and increased their knowledge (100%) and ability to perform D&Es (96%).

Our affordable and simple D&E model can be easily replicated and implemented for training in second-trimester D&E. This model can serve as a valuable and realistic tool for providers with restricted access to clinical abortion who need adjunct training, improving physician education and competency.