Hands-On Learning: Teaching Neonatal Circumcision with an Affordable Simulation Model
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2025
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Abstract
Context:
Neonatal circumcision, the most commonly performed neonatal procedure, is primarily performed by pediatricians or obstetricians. Given differences in parental desires for this elective neonatal procedure across different populations (as high as 89% in Hawaii), opportunities for medical students to gain experience in circumcisions prior to residency are variable. Simulation models for circumcision obtained commercially or those requiring specialized equipment such as 3-D printers can be cost prohibitive for medical training programs. While several models have been studied among pediatric or obstetrical gynecology residents, limited data is available on the effectiveness of circumcision simulation models on medical student learning.
Objectives:
The purpose of this innovation was to develop and evaluate the impact of a low cost, portable, newborn circumcision simulation model that can be quickly assembled with over-the-counter and non-perishable items on medical student circumcision related medical knowledge and self-reported improvement in confidence performing the procedure.
Description of Innovation:
Between 2022 to 2024, 26 fourth year medical students matching into pediatrics participated in a circumcision workshop. Students were given a short didactic going over medical contraindications, benefits, and risks involved with circumcision. A newborn circumcision model was built using a Boon™ bottle drying rack, Similac™ disposable slow flow nipple, Playtex™ tampon plastic applicator, and glove finger tips cut from a Biogel™ size 6 sterile glove. The model was developed and pilot tested by a neonatologist skilled in circumcisions. Faculty demonstrated circumcision using a Gomco clamp on the model and then provided one-on-one guidance as each student demonstrated circumcision skills on the model. The guided practice allowed students to refine their technical skills and build confidence in performing the procedure. Students took a pre-test and post-test to measure improvement in medical knowledge (related to benefits, risks, and key procedural steps of circumcision), and self-rated confidence in their procedural skills using (1= not very comfortable, 5=very comfortable). Results were analyzed using paired student T-test.
Evaluation of Innovation:
Medical students demonstrated improvement in mean ratings of self-reported confidence in explaining the risks (1.96->4.07), steps of the procedure (1.65->4.27), and performing the procedure independently (1.58->4.23), p<0.01 for all questions. Student performance on a multiple choice quiz testing pertinent medical knowledge also improved (mean percentage correct 83->93%, p<0.01). Students found the model realistic (mean score 4.11 out of 5.0) and helpful in learning the procedure (mean score 4.81 out of 5).
Discussion/Key Message:
A portable, easily assembled, and low-cost model of neonatal circumcision was effective in improving medical knowledge and self-reported confidence in procedural skills among inexperienced fourth year medical students, a demographic not previously assessed in the literature. This model has the potential for widespread adoption across other health professions or specialities that may also benefit from circumcision training education. Limitations include lack of anthropomorphic features which detracted from the realism of the model and difficulty in using the scalpel to cut through the glove tip. Future directions will assess the impact of this simulation training model on subsequent procedural performance during the pediatric intern year and retention of skills in senior year to further validate the model's effectiveness and its contribution to clinical practice readiness.
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