High-fidelity telesimulation to teach lactation skills to primary care residents, a cluster randomized educational trial.

backgroundMost primary care physicians lack the clinical knowledge and skills to manage common breastfeeding problems. High-fidelity simulation with standardized patients in videoconferencing or telesimulation increases medical student confidence and competence in clinical lactation skills; yet it is not known if telesimulation at the graduate medical education level results in the translation of lactation skills in medical trainees.

objectiveTo assess the effect of a telesimulation versus videoconferencing didactics on clinical lactation practice patterns in resident trainees.

methodsIn this randomized trial (NCT04519216) pediatric and family medicine residents were randomized to receive one breastfeeding education experience via either [1] traditional didactics through videoconferencing (control) or [2] telesimulation (intervention). The primary outcome was the change in composite standardized clinical lactation practice pattern scores from enrollment to 3 months. Practice patterns and clinical lactation self-efficacy were also collected and reported at post-test, 2-weeks, and 3 months. We conducted a difference-in-differences analysis of mean change scores and a sensitivity analysis was also completed to account for any missing data. Internal validity of the clinical lactation self-efficacy and standardized practice patterns survey batteries were assessed using Cronbach's alpha.

results62 residents received breastfeeding education; of which 51 participated in the study at any time. The mean change in composite practice pattern scores from baseline to 3 months increased in the intervention group to 1.3 (± 1.1) with the control group steady with a score of 0.3 (± 1.0). This difference was not significant as the effect size (per-protocol) was - 1.0 (-2.0, 0.1). Mean change scores from enrollment to 3 months showed an increase in clinical lactation self-efficacy for both groups with a gain of 1.6 (± 0.9) for control and 1.3 (± 0.8) for intervention; however, the effect size (per-protocol) of 0.3 (-0.5, 1.1) showed no significant difference between groups.

conclusionsTeaching breastfeeding medicine concepts and skills for graduate medical education level learners is important. We no significant difference in practice patterns between residents taught breastfeeding medicine concepts through videoconferencing didactics versus telesimulation.