05: The fundamentals of vaginal surgery: developing a model for vaginal surgery skills training

Abstract

Vaginal surgery requires advanced procedural skills to operate in a deep, narrow space. Simulation-based training can develop skills without exposing patients to undue risks. The aim of this study was to create and evaluate a low-fidelity model and select surgical tasks for developing the basic surgical skills utilized in vaginal surgery. In an IRB exempt study (HUM00149766), a multidisciplinary team of urogynecologists, biomedical engineers, and a medical educator was assembled. Hierarchical task analyses (HTA) of common vaginal reconstructive surgeries were performed. Expert panel consensus regarding intended characteristics and basic vaginal surgical skills guided model development and task selection, respectively. The model was created using a 3D printer. The following tasks were selected: (1) one-handed and (2) two-handed knot tying; (3) running (4) horizontal plication and (5) vertical plication suturing; (6) free pedicle ligation, and (7) Heaney transfixion suture ligation. Twelve gynecologists performed the tasks on the model (6 urogynecologists, 4 OB/GYN generalists, and 2 gynecologic oncologists). Participants completed a 34-item survey consisting of eight Likert scales, nine 4-point rating scales (1=strongly disagree, 4=strongly agree; 1=no value, 4=great deal of value), free text and demographic questions. Validity evidence relevant to test content and response processes were evaluated, while evidence of internal structure (inter-item consistency) was estimated using Cronbach’s alpha. SPSS was used for statistical analysis. The range of mean scores (M) for responses regarding the model’s representation of typical vaginal dimensions and support of authentic surgical actions were 3.75-4.58 (neutral to strongly agree). The highest score was for supportive of authentic actions with pedicle ligation (M= 4.58) and the lowest score was for representative of typical vaginal length (M=3.75). All participants either agreed or strongly agreed with incorporation of all tasks in a training program, except one who disagreed with two-handed knot tying. Mean rating scores for Model as a training tool was M=4.0 (consistent with the task trainer has a great deal of value). Inter-item consistency for items evaluating the simulator’s quality was high (α= 0.728). We created a task trainer and identified 7 tasks to be performed that exemplify core vaginal surgical skills with preliminary evidence of validity based on test content, response processes, and internal structure data. Participants rated the model as adequately representative of vaginal dimensions and supportive of authentic surgical actions. The model and tasks were highly rated for value as a training tool. Additional validation evidence will be obtained prior to implementation as a training and testing tool.