Development of a CS Training Phantom to Enhance Clinical Skills and Prevent Iatrogenic Injuries

Abstract

This thesis presents the development of an anatomically accurate and cost-effective training model for cesarean section (CS), specifically designed to meet the needs of junior doctors in low- and middleincome countries (LMICs). The primary objective is to reduce iatrogenic injuries, especially to the bladder and ureters, by providing trainees with hands-on experience in a safe and structured learning environment. The Salama CS training phantom simulates all essential steps of a primary planned CS following the Modified Misgav-Ladach method, including peritoneal entry, bladder flap mobilisation, and uterine suturing with lateral extension. Its modular design, potential realistic haptic feedback, and focus on high-risk
steps make it a valuable educational tool, particularly in settings where surgical supervision is limited. Fieldwork conducted in Tanzania provided key insights into local clinical practices and training gaps. Interviews with clinicians informed design choices and confirmed the model’s relevance for medical students, interns, and junior residents. Technical validation suggests that the silicone uterus may be reusable and indicates that the model is capable of simulating repeated needle penetration while maintaining a realistic level of feedback. Compared to existing training models, the Salama CS phantom stands out by addressing injury prevention
explicitly and by balancing fidelity with affordability. Recommendations for future development include the addition of fetal delivery and simulation of secondary CS involving adhesions, to further enhance training realism and clinical relevance.

Index terms: Cesarean section, LMICs, iatrogenic injury, maternal care, surgical training