Simulation in surgical education: a review of a multi- tiered gynaecological laparoscopy workshop

O J Y Kirsten,L S K Jason,T W K Andy,D F C Wei

doi:10.4038/seajme.v15i1.364

Abstract

Background: While minimally access approach has become the gold standard for many gynaecological procedures, laparoscopic surgery has a steep learning curve and many trainees face challenges acquiring the necessary skills. The aim of our study was to evaluate the effectiveness of a multi-tiered laparoscopy simulation workshop for gynaecology residents. Approach: An observational study was conducted at SingHealth Duke-National University of Singapore (NUS) Institute of Medical Simulation Centre (SIMS) between November 2016 and November 2017. Gynaecology residents were recruited to attend two separate one-day workshops held in November 2016 and November 2017 respectively, involving didactic lectures, dry-lab simulation and animal training. Participants rated various learning domains of the training workshops using a five-point scale Likert in pre- and post-workshop surveys. Findings: The study enrolled 16 residents in total. On a Likert scale from 1 to 5 (1 being poor and 5 being excellent), participants rated significant improvement in domains of general laparoscopy skills acquisition (1.7 + 0.6 to 4.9 + 0.4; p<0.001), dry lab simulation (1.9 + 0.5 to 4.8 + 0.4; p<0.001), confidence in laparoscopy suturing skills (1.1 + 0.3 to 4.8 + 0.4; p<0.001) and laparoscopy knowledge (2.1 + 0.5 to 4.7 + 0.5; p<0.001). Conclusion: A combination of didactic lectures, dry-lab simulation and animal training under expert supervision and guidance dramatically improved surgical skills and confidence in gynaecology residents. Such a multi-tiered format allows for effective learning and acquisition of laparoscopic skills.

Highlights

In recent decades, pelvic laparoscopy and robotic-assisted procedures have progressed from simple diagnostic and therapeutic tools to a complex armamentarium of advanced surgical techniques
Laparoscopic surgery is important for gynaecological practice and has become the method of choice for many gynaecological procedures given relative advantages over open surgery, such as faster recovery, reduced post-operative pain and shorter hospitalisation stay (Johnson et al, 2006; Walker et al, 2009)
Recovery in Gynaecology strongly supports the use of minimal access surgery to improve post-operative recovery (RAF Crawford, 2013)

Summary

Introduction

Pelvic laparoscopy and robotic-assisted procedures have progressed from simple diagnostic and therapeutic tools to a complex armamentarium of advanced surgical techniques. Laparoscopic surgery has a steep learning curve that requires psychomotor skills different from those needed for open surgery. It poses many technical challenges including camera navigation, handbrain coordination, limited range of motion of laparoscopic instruments and appreciation of depth and orientation using a two-dimensional screen. Laparoscopic skills simulation programmes have been shown to refine the skills that are essential for minimally invasive surgical procedures in a controlled setting outside of the operating theatre (Houck et al, 2013; Schwab et al, 2017). While minimally access approach has become the gold standard for many gynaecological procedures, laparoscopic surgery has a steep learning curve and many trainees face challenges acquiring the necessary skills. Participants rated various learning domains of the training workshops using a five-point scale Likert in pre- and post-workshop surveys

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Discussion

Conclusion