Integration of Cystoscopy Into OBGYN Junior Residency Curriculum: A Simulation-Based Approach

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Abstract

BACKGROUND:

Lower urinary tract injuries present serious challenges for the obstetrician gynecologist. Recently, innovative surgical techniques have been employed to improve visualization and dissection of pelvic anatomy. Despite these advances, lower urinary tract injury during hysterectomy is still our greatest peril. Intraoperative recognition and immediate surgical repair can greatly reduce post-operative morbidity and medical-legal ramifications.

METHODS:

Participants were junior residents (PGY-1 and PGY-2) in the OBGYN Residency Program at Inova Fairfax Medical Campus. The cystoscopy curriculum consisted of a 1 hour didactic session and a 3 hour simulation session. The didactic session examined characteristic properties of the bladder, including an overview of the procedure. The simulation session incorporated a skills workshop with repeated practice on low fidelity models. Pre- and post-assessments included a cognitive exam, a confidence survey, and validated checklists (OSATS). After 6 months, final acquisition of skill was tested in the operating room.

RESULTS:

PGY-1 and PGY-2 residents showed significant cognitive (P=.0008/.003) and confidence (P=.04) improvement, with no difference between groups. For checklist items, there was significant improvement within groups for Cystoscope Assembly (P=.007), Bladder Survey (P=.0002), Total Score (P<.0001), Global Rating (P<.0001), with no differences between groups.

DISCUSSION:

The simulation based curriculum was effective in training junior residents the basic skills of cystoscopy. This curriculum can be utilized as a teaching tool for residents to become confident and proficient in the aspects of diagnostic cystoscopy.

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