Fellow performance assessment after completion of the American society for reproductive medicine embryo transfer simulation certificate course

Abstract

The primary objective of this study was to determine if Reproductive Endocrinology and Infertility (REI) fellow performance of embryo transfer (ET) improved with simulation. A descriptive cross-sectional study evaluated whether the American Society for Reproductive Medicine (ASRM) ET simulation certificate course improved fellow performance in ET. A total of 7 fellows (2 first years, 2 second years, and 3 third years) worked through a 6 week training course with reading materials, course proctors, and individual practice sessions. Each fellow performed a total of 120 ET simulations using three different transfer techniques with four uterine models each increasing in level of difficulty under real time ultrasound guidance. Uterus A was a midline short uterus, uterus B was sharply anteverted, uterus C had a tortuous cervical canal, and uterus D had a false passage. Each simulation was graded based on ability to virtually place an embryo more than 1 cm from the fundus, without touching the fundus, within two minutes of starting simulation, and without more than two passes of the inner catheter through the internal os. There was opportunity for feedback after each session. Descriptive analysis was performed comparing average scores per fellow year during the first 5 transfers performed to the last 5 transfers performed for each uterine model and overall. Overall each fellowship year had improvement in ET scores upon completion of the course when comparing the average score for all uterine models for the first 5 transfer simulations to the last 5 (0.67%, 8.19%, and 15.56% for years 1, 2, 3 respectively). Comparing the first 5 transfer simulations to the last 5 for uterus A showed ET score improvement by 1.18%, 3.67%, and 38.44% respectively for each increasing fellowship year. For uterus B fellowship year 1, 2, 3 also improved by 1.91%, 9.25%, and 9.44% respectively. For uterus C there was no change in the scores for year 1, however year 2, 3 improved by 12.21% and 4.97% respectively. For uterus D year 1 fellows decreased scores by 0.5% while year 2 and 3 increased scores by 8.09% and 13.31% respectively. Level of training did not reflect experience with ET prior to the start of the course. The ASRM ET certificate course improved performance for each fellowship year overall, regardless of ET difficulty, with more accurate placement of the embryo in the ideal location. However, the benefit of the course was more evident in fellowship year 2 and 3. This data suggests that use of this simulator will enhance fellow capability of performing ETs and standardize training in REI fellowships.