Barriers to Office Hysteroscopy in Fellowship Education and Practice

Abstract

Study objectivesTo identify the top 3 perceived barriers to performing office hysteroscopy by MIGS faculty and fellows and identify opportunities for education on this key topic that will be most effective in fellowship training and MIGS practice. DesignCross-sectional survey study targeted at all AAGL-accredited FMIGS fellows, program directors, and associate program directors in February-April 2022. The survey was designed by faculty who have extensive experience in office hysteroscopy procedures. Additionally, a literature search was performed to aid with question design. Setting, patients and interventionsThis was a RedCap electronic survey administered through the FMIGS listserv. No additional follow-up was performed after survey completion. The 15-minute survey was sent to 60 program directors, 92 assistant program directors, and 158 fellows, including the incoming class of 2024 and the 2022 fellowship graduates. Measurements and main results93 responses were received. 67% of respondents performed office hysteroscopy (OH) but 73% of those performed 5 procedures or less per month. The majority of participants controlled pain with NSAIDs +/- paracervical block. The most common perceived barrier to performing OH was concern over pain management. Other commonly cited concerns were equipment costs, sterilization costs, and office staff training. 37-44% of respondents also cited lack of departmental support and insufficient clinic time, respectively, as barriers. 56% indicated they are interested in educational materials on OH. ConclusionOur study suggests general interest in, but low volume of OH amongst MIGS fellows and faculty. The most common perceived barrier was concern regarding pain management. This has been well studied in the literature and likely presents an area for greater education to improve OH utilization. We also uncovered concerns regarding systemic barriers, such as equipment costs, departmental support, and clinic structure. This is an area for further research and advocacy efforts to address barriers to OH on a system level.