Hysteroscopy training and learning curve of 30° camera navigation on a new box trainer: the HYSTT

Abstract

Despite the upcoming use of hysteroscopy and increased applicability during the last decades, little work has been done regarding the development of hysteroscopic training models in comparison to laparoscopy. Camera navigation is often perceived to be an easy task, but it is far from an innate ability, especially when an angled optic is used. This study investigated the learning curve of hysteroscopic 30° camera navigation on a new box trainer: Hysteroscopic Skills Training and Testing (HYSTT). This prospective study (Canadian Task Force II-2) enrolled 30 novices (medical students) and ten experts (gynecologists who had performed >100 diagnostic 30° hysteroscopies). All participants performed nine repetitions of a 30° camera exercise on the HYSTT. Novices returned after 2 weeks and performed a second series of five repetitions to assess retention of skills. The parameter procedure time and structured observations on performance using the Global Rating Scale provided measurements for analysis. The learning curve is represented by improvement per procedure. Two-way repeated-measures analysis of variance was used to analyze learning curves. Effect size (ES) was calculated to express the practical significance of the results (ES ≥0.50 indicates a large learning effect). For both parameters, significant improvements were found in novice performance within nine repetitions. Moderate to large learning effects were established (p < 0.05; ES 0.44–0.71). Retention of skills and prolonged learning curves were observed. The learning curve, established in this study, of hysteroscopic 30° camera navigation skills on the HYSTT box trainer, indicates a good training capacity and provides the first step towards recommended implementation into a training curriculum.