A Comparative Analysis Using Endoscopic Simulation to Assess Surgical Skill of OB/GYN Residents

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BACKGROUND:Endoscopic skill curriculums using simulation tools have proven to be efficacious in training and in evaluating competency in residents performing endoscopic procedures. OB/GYN residents in a single institution were evaluated using various modalities in the simulation setting. There are few data on the value of endoscopic simulation in assessing efficiency, dexterity, and technical ability and how it compares with actual OR performance of trainees.METHODS:This study was a prospective, observational study, assessing skill in simulation exercises in hysteroscopy, laparoscopy, and robotics. Performance results were compared to surgical experience based on residents' OPLOG data, NewInnovation surgical evaluation scores, and endoscopy-specific milestone assessment. The study included all OB/GYN residents from a single training program. Testing was performed in 11 different exercises using simple box trainers and computer simulators for laparoscopy (Symbionix) and robotics (Mimic). Scoring included time, with alteration for errors or dangerous movements, and efficiency based on path of motion.RESULTS:When comparing PGY year versus total time, the average total time decreased as PGY level increased for all exercises except for the Symbionix laparoscopic trainer. This trend was also consistent for efficiency and motion metrics. These performance metrics were also better in residents who had completed a larger number of actual operative procedures. Resident performance in the simulated setting, however, did not correlate well with prior surgical evaluations or endoscopic milestone assessments.DISCUSSION:Implementation of a multimodal simulation curriculum focused on endoscopic procedures could provide a safe, and objective means than may be used to evaluate endoscopic performance of residents. Performance on simple skill correlates positively with level of training and prior experiential numbers. There was little correlation between resident performance and past resident surgical evaluations used in our institution. Based on these data, we are considering surgical evaluation paradigm that combines both simulation and actual procedural performance metrics.

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