Faculty Attitudes Towards TVH and Impact of Vaginal Hysterectomy Simulator

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Abstract

BACKGROUND:

Resident education is dependent on the expertise of faculty. Many residents are graduating with the minimum acceptable number of TVHs. Increasing the number TVH scheduled by faculty, will have a tremendous impact on resident education.

METHODS:

Attending physicians practicing gynecology at a large University hospital were surveyed regarding experience and current practice with performing TVH. Physicians were asked to identify perceived difficulties or barriers with the procedure. OR logs were reviewed for the number of TVHs performed by provider. Faculty members used a vaginal hysterectomy simulator with guidance by a gynecologic expert. A post intervention survey was distributed. OR logs will be pulled for the year after the intervention.

RESULTS:

Less than 50% of faculty reported being very comfortable with TVH. All participants had performed twenty or fewer TVHs during training. Anterior entry was identified as the most difficult step. Over half reported they would more likely do a TVH if they could double scrub. Results from use of the simulator are to be reported at a later date.

DISCUSSION:

There is ample data that TVH is the safest and most cost effective mode of hysterectomy when feasible. There is also data that volume of cases has an impact on surgical outcomes. At present, all faculty were considered low volume surgeons. This underscores the importance of increasing faculty comfort level with TVH so that residents can be trained adequately. In addition, additional support should be provided for anterior entry as most respondents identified that as the most difficult part of the procedure.

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