Correlation of Surgical Case Volume and Fellowship Training with Simulated Procedural Tasks

Abstract

Study Objective To determine an association of surgical case volume and fellowship training with simulated procedural tasks Design Quality initiative via simulation Setting Two academic hospitals Patients or Participants Obstetric and gynecologic (Ob-Gyn) surgeons. Interventions All 109 participants were required to complete a pre-test survey followed by tasks on the Surgical Science LapSim® laparoscopic simulator. A post-test survey was administered. Measurements and Main Results The pre-test survey inquired about average monthly laparoscopic case volume and prior training. Simulation included a basic skills task (peg transfer) followed by a procedural task (salpingectomy). Spearman correlation and Wilcoxon tests determined correlations between survey responses and performance parameters. Participants included generalists and fellowship-trained specialists (38%). Surgeons with higher surgical volume (6-10 and 11+ monthly cases) completed the salpingectomy task quicker and with less blood loss than surgeons who operated less frequently (p = 0.001, 0.004). Economy of movement (instrument path length) was more efficient among high volume surgeons (p = 0.003). Surgeons with fellowship training performed more quickly, efficiently, and with less blood loss compared to generalists (p = 0.001, 0.001, 0.004). There was no difference in ovarian thermal damage regarding case volume and fellowship background (p = 0.67, 0.43). Additionally, there was no difference among most performance parameters for the peg transfer task. Conclusion Surgical experience regarding higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a prior study, we found similar correlation with simulated basic skills tasks. In the current study, there was no such correlation with the peg transfer task, likely due to familiarity of the task from the prior study. The current study is a continuation of an ongoing quality initiative to establish a validated simulation program for maintenance of credentials among Ob-Gyn surgeons. Future studies will compare prior simulation scores with validated surgical assessments, operative metrics, and surgical outcomes.