Hysteroscopy is a fundamental gynecologic skill that allows direct visualization of the uterine cavity. Many residency programs have incorporated simulation activities into their training. The objective of this study was to determine if a simulation program using a virtual reality resectoscope would improve medical knowledge, surgical skill, and confidence of residents performing a hysteroscopy.
A pre-posttest model was used to assess the effectiveness of implementing a simulation curriculum into obstetrics and gynecology residency training. The primary components of the curriculum included didactic review, demonstration and practice using a hysteroscopy simulator. Outcomes were measured comparing knowledge test scores, performance assessments using a validated scoring system (percent of pathology removed, safety, economy, visualization, and fluid handling) and subjective surveys to assess comfort and confidence with hysteroscopic procedures.
Six interns participated in the simulation program. The mean knowledge exam score improved 37.9 percentage points (95% CI 21.2–54.6, P<.01), the average overall simulator score improved 28.3 percentage points (95% CI 13.9–42.8, P<.01), and the percentage of simulator categories that each individual completed at goal improved 26.5 percentage points (95% CI 13.6–39.5, P<.01). The subjective surveys indicated a significant improvement in confidence with hysteroscopy from 1.8 to 4.1 on a 5-point Likert scale (95% CI 1.6–3.1, P<.01).
Trainees experienced statistically significant improvements in knowledge, surgical skill assessments, and subjective confidence related to hysteroscopic procedures. Implementing a formal simulation curriculum to novice residents yields rapid improvements to hone skills in a less pressured environment in order to safely operate on future patients.
Inova Health System, Falls Church, VA
Financial Disclosure: The authors did not report any potential conflicts of interest.