Modification of Fundamentals of Laparoscopic Surgery Manual Skills Curriculum with Addition of a Vaginal Cuff Closure Task.

Abstract

Study Objective Obstetrics and gynecology (OBGYN) residents are required to pass a Fundamentals of Laparoscopic Surgery (FLS) exam to qualify for written boards. FLS exam validity evidence has been questioned recently and concerns have been raised with its applicability to gynecologic surgical training. We present preliminary data from a pilot study which aims to correlate performance on FLS manual skills to a vaginal cuff closure model in a simulated setting. Design Prospective descriptive study Setting OBGYN residency program at a large urban academic medical center. Patients or Participants OBGYN residents in post-graduate year three. Interventions In addition to the standard five FLS tasks, participants are introduced to a previously studied vaginal cuff closure model during a teaching session. Before taking FLS exam, they are evaluated on a cuff closure using the modified Global Operative Assessment of Laparoscopic Skills (GOALS) and a task-specific checklist. After assessment, residents filled out a usability survey. Measurements and Main Results Seven residents participated between July and December 2019. The mean time to completion of the cuff closure was 14.6 minutes (SD= 2.2 minutes) and range of 12.5 to 18.5 minutes. In our sample size of 7, we did not detect a correlation between official composite FLS and vaginal cuff scores as measured with GOALS (rho = 0.1070, p = 0.819) or the checklist (rho = 0.359, p = 0.429). All residents found the cuff to be a useful addition to curriculum and preferred to replace an FLS task with the cuff model. We plan to continue enrollment of 11 residents per year for four years, to reach a sample size of 44. Conclusion In this preliminary analysis of a pilot study, we did not find a correlation between performance on a vaginal cuff task trainer and FLS manual skills. Residents preferred cuff closure to FLS tasks.