Transvaginal Hysterectomy Error Identification: A Pilot Study of OBGYN Residents

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Abstract

Local Mentor:

Dionysios K. Veronikis, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:

To investigate the ability of obstetrics and gynecology (OBGYN) residents to identify the potential errors that occur during transvaginal hysterectomy (TVH).

METHODS:

A cognitive task analysis (CTA) on TVH with critical decision points and potential error was utilized as the framework for a cross-sectional questionnaire that was disseminated to OBGYN residents at a community-based residency program. They were provided the critical decision points and asked to identify the error and their confidence to avoid, recognize, and manage the error. Residents identified their post-graduate year (PGY) level and “surgeon” experience with TVH based on case logs. An iterative process was performed with three OBGYN faculty and one resident to score the resident answers as incorrect, partially correct, or correct. A predictive model was created to analyze the data.

RESULTS:

There were 21 responses with similar representation of PGY levels. The proportion of surgical errors accurately identified and PGY level was positively correlated (P=.002) with the greatest change between PGY2 and PGY3 (P=.012). There was a significant increase in the accurate identification of errors after 21 cases as “surgeon” (P=.013), which was the mean volume of PGY3 case experience. A significant association was noted between the number of TVH performed and accurate error identification in anterior entry and uterosacral and cardinal pedicle procurement (P<.05).

CONCLUSION:

Progression from PGY2 to PGY3 and 21 cases is associated with an increased accuracy in identification of TVH. The resident experience in performing TVH is the driving factor in a resident’s overall ability to accurately identify potential surgical error.

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