The Art of Manipulation: Preparing the Learner for Uterine Manipulation in Laparoscopic Hysterectomy

Abstract

<h3>Study Objective</h3> To determine whether kinesthetic learning using a simulated pelvic model while learning the uterine manipulation maneuvers of a laparoscopic hysterectomy improves learning compared to an interactive video module alone. <h3>Design</h3> Randomized controlled study. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> Forty, first-year and second-year medical students who had never performed uterine manipulation <h3>Interventions</h3> A low-cost simulated pelvic model for kinesthetic learning during an interactive video module. <h3>Measurements and Main Results</h3> Forty, first-year and second-year medical students participated in the study, which included an interactive video module with formative assessment, summative assessment, cadaveric assessment, and qualitative post-participation survey. Participants were randomized to the intervention group (n=21) who used a simulated pelvic model for kinesthetic learning during the video module or the control group (n=19) who only had the video module to learn the uterine manipulation maneuvers of a laparoscopic hysterectomy. There was no difference between the control and intervention groups on final score, number of attempts, or time to completion of the summative assessment. On the cadaveric assessment, participants in the intervention group had fewer unnecessary movements with demonstration of both right pelvic sidewall (control 78.9%, intervention 42.9%, p<0.027) and left pelvic sidewall (control 94.7%, intervention 66.7%, p<0.046). This difference was increased in more novice first-year medical student participants (p<0.009). There was no difference between the control and intervention groups in the amount of force used, need for either verbal or physical cues, or time required to achieve each maneuver. Lastly, the participants in the intervention group reported higher perceived preparedness (100% versus 71.4% in control group, p<0.037). <h3>Conclusion</h3> Kinesthetic practice may not be required for learning the uterine manipulation maneuvers of a laparoscopic hysterectomy, but it may be beneficial for more novice learners and to increase learners' perceived preparedness. Our interactive video module alone may be sufficient to prepare learners to perform uterine manipulation maneuvers prior to the operating room.