Describing Surgical Skill Learning Curves in OBGYN Residency: A Process Using myTIPreport

Abstract

Faculty Advisor: Nancy Gaba, MD PURPOSE: To describe a process for generating procedural learning curves in OB/GYN Residency. BACKGROUND: Most data demonstrating OB/GYN resident surgical proficiency have used operative time as a surrogate for proficiency. The actual number of procedures required to achieve proficiency has not been reported. Our goal was to describe a process for reporting the number of procedures needed to achieve a mean “Supervision Only” rating as reported by faculty using the myTIPreport program. METHODS: This descriptive study was a secondary analysis of the myTIPreport database from July 2015–June 2016. For this database, each resident receives a procedure-specific surgical proficiency score, rated 1-5, with surgical proficiency defined as Level 4 (Resident requires “Supervision Only”). Using database time stamps, chronologic case numbers were generated. Fitted Linear Modeling was used to generate an approximate number of cases to achieve this proficiency. To reduce the effect of prior experience influencing the data, only PGY-1 residents were included. To reduce type I error, procedures were examined when at least 100 feedback encounters were reported. RESULTS: Of the 1045 intern feedback encounters reported, 2 procedures met inclusion criteria. Using this modeling, PGY-1's needed 13 cesarean deliveries to achieve a mean Level 4 rating. Similarly, 9 procedures were needed for PGY-1 spontaneous deliveries. DISCUSSION: A process for reporting surgical skill progression for PGY-1 learners on select procedures was demonstrated using the myTIPreport program. Learner and faculty development tool use may allow for both establishing “learning curves” for other procedures as well as eventually allow for earlier identification and remediation of at-risk learners.