Major Vascular Injury (MVI) Simulation in Gynecologic Surgery: Teaching Intraoperative Crisis Management Skills

Abstract

Study Objective To implement major vascular injury (MVI) in gynecologic surgery simulation. Design Development and evaluation of a gynecology-based operating room (OR) simulation. Setting Simulation center at the 2019 AAGL Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) Annual Bootcamp Patients or Participants Postgraduate year (PGY) 6 fellows participated as learners. Faculty oriented learners and lead the debriefing. Interventions MVI simulation session. Measurements and Main Results Pre- and post-simulation survey responses were compared using McNemar’ test. Median and interquartile ranges were calculated on responses collected via a Likert scale (1-5). A total of 34 fellows (median age 31.5) and 8 faculty (median age 37.5) responded. Fellows reported a median 8 hours per year spent participating in simulation team training and a median 5 hours per year spent teaching in this context. All fellows believed that simulation training is both an essential part of clinical practice and patient safety. 94.1% (n=32) thought that simulation team training should be a part of the boot camp. 94.1% (n=32) also thought that the training should be part of the fellowship curriculum in their respective institutions. Before the simulation, 97.1% (n=33) of the fellows desired to learn more about simulation training and curriculum development. Following the simulation, all fellows felt that knowledge gained could be transferred to the clinical setting, felt more confident in responding to a critical intraoperative event, learned techniques to communicate more effectively during a critical event, and felt that the simulation content was relevant to their training and clinical practice. The majority of the fellows felt more confident in managing intraoperative hemorrhage (median 5, IQR 4-5) following the simulation. Conclusion MVI training in gynecologic surgery is feasible and viewed favorably by participants. Further work should focus on performance assessment and clinical outcomes to allow for growth of simulation training within the field of gynecology.