Assessment of Gynecologic Laparoscopy Simulation Curriculum for Development of Fundamentals of Laparoscopy Surgery Psychomotor Skills.

Abstract

Study Objective To investigate the utility of a gynecologic laparoscopy simulation curriculum designed for mid-level obstetrics and gynecology (OBGYN) residents in the five Fundamentals of Laparoscopy Surgery (FLS) skills. The hypothesis was that residents would demonstrate significant improvement in all tasks. Design A cohort study. Setting A community based OBGYN residency education program. Patients or Participants A total of 51 2nd and 3rd year residents. Interventions A comprehensive, 10 – week-long gynecologic endoscopy program, comprising both cognitive and manual skills. After an orientation week, formal assessment of baseline time and accuracy for each of the 5 FLS exercises was obtained on each resident by an FLS-certified faculty. Each week thereafter comprised a 3-hour training session with the same faculty that included approximately 90 minutes of hands-on psychomotor training using the FLS Laparoscopic System. All residents had 24 hour a day access to a training facility. On week 9, formal testing was repeated by the same faculty and the data entered into an Excel database. Measurements and Main Results There were 51 residents in the 10-year period and between 38 and 46 pairs of data for the 5 skills were evaluable. The baseline and week 9 completion times in seconds (SD) were as follows: Peg transfer 90.8 (40.1) and 59.4 (20.5); Pattern cut 190.7 (87.9) and 113.8 (51.0); Ligating loop 92.1 (39.6) and 65.1 (31.2); Extracorporeal tie 230.9 (88.3) and 137.8 (42.2); Intracorporeal tie 249.3 (97.9) and 134.1 (69.5). All differences were significant P Conclusion Mid-level OBGYN residents exposed to this gynecologic laparoscopy simulation training program significantly improved performance in the five FLS skills. Consequently, it may serve as a model for residency training programs. However, the absence of a cognitive and psychomotor hysteroscopic component in FLS is noteworthy and a shortcoming for OBGYN training programs.