Surgical Competence: Evidence to Implementation

WiP Seminar: Dr. Roxana Geoffrion

This is a hybrid event, you may attend in person (St. Paul’s Hospital) or virtually. Please register and indicate your preference.

Summary:

Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents’ confidence and preparedness for vaginal surgery has plummeted in the past decade. Existing training models are expensive and not fully validated.

We developed a procedure-specific vaginal surgery simulation curriculum to improve competence of novice gynecologic surgeons. Our curriculum includes didactic and practical low-fidelity simulation models for three surgical procedures (anterior repair, posterior repair, vaginal hysterectomy). Learners proceed with online didactic modules, followed by a post-test of knowledge. They then proceed to practice of relevant surgical skills on models in the surgical lab, followed by a post-test of proficiency, including timing and errors.

Fifty-five residents completed our multicentre randomized controlled trial and were randomized to our curriculum or usual training. We showed face and content validity, adequate inter-rater reliability, good internal consistency and transferability of acquired skills to a real operating room (OR) environment and for corresponding procedures. We established pass-fail scores for purposes of summative assessment. Intervention residents showed greater procedural steps knowledge and self-confidence in the real OR. This year, we implemented this curriculum into standard surgical education of second year residents enrolled in the Obstetrics and Gynecology residency program at the University of British Columbia, and recorded implementation costs.

Our validated procedure-specific modular training curriculum includes formative and summative assessment in a low-stakes environment and enhances operative competence and self-confidence of novice learners.