Female Pelvic Medicine & Reconstructive Surgery:
1Obstetrics Gynecology, University of Texas @ Houston, Houston, TX; 2Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; 3Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC; 4Obstetrics and Gynecology, Orlando Health, Orlando, FL; 5Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA; 6Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX; 7Obstetrics and Gynecology, Ochsner Health System, New Orleans, LA
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
To determine whether training on previously validated laparoscopic skill stations translates into improved technical performance in the operating room.
MATERIALS AND METHODS:
We performed a multi-center randomized controlled trial evaluating the performance of Ob/Gyn residents during a laparoscopic sterilization procedure via bilateral midsegment salpingectomy. Eligible participants were defined as all OB/Gyn residents in post-graduate years 1–4 from ACGME accredited programs. We categorized PGY 1/2's as lower level (LL), and PGY 3/4's as upper level (UL).
We used the following five previously validated exercises: Pegboard transfer, Pattern cutting, Endoloop, Intracorporeal and Extracorporeal knot tying. After participants performed one laparoscopic salpingectomy, they were block randomized and stratified by level of residency (LL, UL) to laparoscopic simulator training versus usual instruction. The intervention group received five 30-minute sessions with an expert laparoscopic surgeon to practice each of the five exercises. In the operating room, we used the most validated method of technical skills assessment to date, the University of Toronto's OSATS, which includes a series of detailed, dichotomous, task-specific checklists along with a separate global rating scale.
Our null hypothesis is that intervention with laparoscopic skills simulators will not improve performance in the operating room. Using previously reported data, a sample size of 44 PGY 1/2's and 66 PGY 3/4's were necessary to demonstrate a 50% improvement in performance, assuming an alpha error = 0.05 and a beta = 0.20 for each group independently. Construct validity was assessed by analyzing resident performance using a one-way analysis of variance, with resident year as the independent variable. Pass-fail data were analyzed with Chi-square.
The study was designed to recruit 61 residents in control (28 LL,33 UL) and 62 in training group (29 LL,33 UL) from 7 different centers across the US. At baseline there were no differences in age, exposure to laparoscopy, experience with simulators, or video game use. Table 1 illustrates the performance in the operating room pre and post intervention within and between both groups. There was no statistically significant difference in baseline performance. Although both groups demonstrated improvement with time, the trained group improved significantly more.
We found that proficiency based simulation offers significant benefit over traditional gynecologic education for all levels of residency. The use of easily accessible, low fidelity tasks should be incorporated into formal laparoscopic training.