Development of a Proficiency-Based Simulation Training Model for Laparoscopic Vaginal Cuff Closure

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Faculty Advisor:Amy Boardman, MDPURPOSE:To evaluate if a low fidelity simulation model and training video will improve resident surgical performance of laparoscopic vaginal cuff closure.BACKGROUND:Laparoscopic surgical complexity and resident work-hour restrictions have increased the need for surgical simulation in OBGYN residencies. Evidence of transfer of acquired surgical skills from simulation to the operating room (OR) is limited.METHODS:This prospective, randomized study compares resident surgical skills acquisition after low-fidelity simulation training of vaginal cuff closure versus no intervention. Study phases include development of a vaginal cuff closure training video; video documentation of resident lab performance; and video assessment of resident surgical skill by blinded surgical experts using I – GOALS, II – error events, and III – surgical checklist.RESULTS:OBGYN residents (N=18) from MedStar Georgetown and Washington Hospital Center were randomized to control group (N=7) or intervention group (N=11). Intervention group reviewed the training video on laparoscopic vaginal cuff closure. All residents then used the low-fidelity cuff closure model and recorded baseline videos. Three surgeons scored the videos with an inter-rater reliability of 0.585, 0.531, and 0.825 for tests I, II, and III. Wilcoxon Rank Sum test was used to evaluate differences between groups by averaging all raters’ scores. There was significant difference between the control and intervention groups for Test II (P=.01) but no difference between the control and intervention groups for tests I and III.DISCUSSION:Simulation training of laparoscopic vaginal cuff closure reduces error events after immediate exposure. Continued research will evaluate if acquired skills transfer to OR performance.

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