The students’ average age was 26.8 ± 0.9 years. The extreme ages were 25 and 29 years old. Among the 38 students, 20 (52.6%) were male. The sex ratio was therefore 1.1. In terms of nationality, there were 31 (81.6%) Burkinabe, 4 Chadians, 2 Beninese, 1 Cameroonian. Thirty students had completed their secondary education in Benin, four in Ivory Coast, two in Chad, and two in Cameroon. Table 1 shows the sociodemographic characteristics of the students.

Thirty-eight (38) 7^th grade students participated in this initial assessment. The average score was 48.2% for theoretical knowledge with extremes of 22.2% and

88.9%. The mean score for the initial evaluation of interval IUD insertion on an anatomical model was 34.4%. The extreme scores were 0% and 66.7%. Before training, the average global score (theoretical knowledge and performance for interval IUD insertion) was 37.4% with extremes of 15% and 65%.

All the 38 grade 7 students took part in the training assessment. The mean for theoretical knowledge score was 93.0% ± 6.4%. The extreme scores were 77.8% and 100.0%. All 38 grade 7 students took part of after training assessment on infernal UID insertion using anatomical model. The average score was 92.8% with extreme scores of 63.6% and 100%. The average global score was 92.9% with extremes of 85% and 100%. Figure 1 shows the results of the answer to theoretical questions and practice per student. Figure 2 shows the boxplot of global score before and after training.

Figure 3 compares the average scores by 7^th grade students in the assessment of theoretical knowledges before and after training. The theoretical knowledge score was higher after training that before it. The difference was statistically significant. Figure 4 compares the average scores obtained by 7^th grade students in the assessment of skills on anatomical model before and after training. The skills’ score was higher after training that before it. The difference was statistically significant.

Table 2 gives the responses of 7^th grade students at the assertion “skills laboratory is a good learning tool”. Ninety-seven-point four percent (97.4%) of 7^th grade students either agreed or strongly agreed with the statement. Table 3 gives the responses of 7^th grade students to the assertion “the skills’ laboratory helped me in acquiring skills for the interval IUD insertion”. All 7^th grade students were either agreed or strongly agreed with the statement.

The purpose of this study was to evaluate the impact of the training on the improvement of trainees’ knowledge and skills on the insertion of the interval IUD. One of the weaknesses of the study is that it did not take into account all 7^th grade students of the promotion. In fact, not all trainees are doing the Obstetrics Gynaecology stage at the same time. They are divided into several groups and each group does their internship for 3 months. Another weakness is the simulation tool used which does not allow a perfect reproduction of the reality of interval IUD insertion in a real woman. Despite these weaks, the study has a strength in that it has an analytical study which compared knowledge and skills of 7^th grade students before and after training. In addition, the assessment was done by the same teachers thus reducing the risk of variability of appreciation.

Our study showed how a short theoretical training followed by the use of simulation on anatomical model can help the acquisition of knowledge and clinical skills. Martineau et al. [5] have shown that learners’ feedback facilitates the learning of complex gestures. In our study, this feedback was made by peers (the other 7^th grade students) and teachers. The use of the learning card has allowed the standardization of clinical competence. The initial level of knowledge and clinical skills of our 7^th grade students was very insufficient and required a good training and supervision. The acquisition of complex gestural skills such as the insertion of an interval IUD requires progressive learning. According to the model of Fitts and Posner [6], the first phase is cognitive learning each elemental step of the skill. The theoretical presentation and the demonstration done by the teachers allowed this elementary learning of the steps of insertion of the interval IUD. This phase also requires the attention of the learner who must follow the steps and memorize them. The second phase is the assimilation that allows to move from the knowledge of the elementary stages to a sequence of coordinated elementary gestures. This phase therefore requires good concentration on the part of the learners and careful monitoring by the teachers. The third phase is that of automation. During this phase, the learner will progressively empower the sequence of elementary steps. In our study, the use of anatomical model probably facilitated these steps. Indeed, the anatomical model being an inanimate object, the learner is less afraid of failing and harming the health of a person. The effectiveness of simulation in the acquisition of complex skills has been demonstrated by a few studies [7] [8] [9] [10] [11]. The dogma “observe, realize, teach” becomes “observe once, simulate many times, perform once with skill and teach everyone” [12] [13]. Our results have shown a clear improvement in knowledge and skills by using simulation on anatomical model. It is therefore essential that training be continued on humans in the family planning unit. This last phase of human training to achieve proficiency can be short because of prior training on an anatomical model. This teaching was punctual as part of the study. As the results suggest that it was beneficial, it would be interesting to do this type of training for all garde students for the main procedures in obstetrics and gynecology. Achieving this objective requires a great challenge of financial, material and human resources that are difficult to mobilize by African universities whose budgets are often very limited.

Currently, the assessment of medical students focuses on theoretical knowledge. The assessment on the procedures is not made or is considered erroneously acquired at the end of courses. In this context, the results of this study have two interests. First, it provided evidence that the simulation on anatomical model allows the acquisition of skills and must be developed. Secondly, it is usable for assessing the skills of students. For these reasons, the anatomical models can be used in the acquisition of skills in the curriculum of training and for evaluation as suggested Bashankaev et al. and Munshi et al. [14] [15].

The students of grade 7 had a good appreciation of the training by simulation using the anatomical model in the clinical skills laboratory. All recognized that this laboratory has been of great help to them in acquiring clinical skills. Other authors like Lemay et al., Nash and Harvey, Falloon, and Juhary also found that learners appreciate the use of simulators in their training [7] [16] [17] [18]. This positive perception by the learners is a factor of good attendance at teaching sessions. In our study, all 7^th grade students who started training completed this.