Multi-institutional Validation of a Vaginal Hysterectomy Simulation Model for Resident Training

Abstract

The purpose of the research was to both develop a vaginal hysterectomy model with surgically pertinent anatomic landmarks and assess its validity for simulation training. Design: A low-cost, reproducible vaginal hysterectomy model with relevant anatomic landmarks for key surgical steps. Setting: Nine academic and community-based obstetrics and gynecology residency programs. Participants: One hundred sixty-nine obstetrics and gynecology residents. Interventions: A vaginal hysterectomy model with surgically pertinent anatomic landmarks was developed and tested for construct validity. Measurements and Main Results: Of the 184 available residents, 169 (91%) participated in this study and performed a vaginal hysterectomy procedure on the described model. The validated objective 7-item global rating scale (GRS) and the 13-item task-specific checklist (TSC) were used as tools to assess performance. The median TSC and GRS scores correlated with year of training, prior experience, and trainee confidence. In addition, the TSC scores also correlated with the GRS scores (p <.001) with regard to performance and resident year of training. Receiver Operator Curves for identification of the residents meeting national residency accreditation minimum numbers for vaginal hysterectomy using the GRS and TSC scores had an area under the curve of 0.89 and 0.83, respectively. Conclusion: This reduced-cost vaginal hysterectomy model offers high construct validity and pertinence for simulation.

Standard Setting in Simulation-based Training of Surgical Procedures

“…Seven of the included studies used this method to identify the score that best differentiates between competent and noncompetent-and similarly to the contrasting groups' method-an external variable is needed to define the examinees (ie, novices vs. experienced). 41,[74][75][76][77][78][79] Using ROC, Habaz et al 75 suggested that their pass/fail score should not be looked at as a summative assessment score but rather a score meant to provide the learners with a benchmark to track their own progress over time.…”

How to teach vaginal surgery through simulation

“…On the other hand, if it is important to achieve competency for an entire procedure prior to operating room debut and a group of surgeon-educators is available to share the time commitment of 2-hour sessions per each resident, then the PROMPT (PRactical Obstetric Multi-Professional Training) shoulder dystocia model could be used (TABLE, page SS6). [10][11][12][13][14] Learning curves Ideally, educators would like to know how many simulated training sessions are needed for a learner to reach a proficiency level and become operating room ready. Such information about learning curves, unfortunately, is not available yet for vaginal hysterectomies.…”

“…Many models created and described in the literature are variations of the models mentioned above, and many use commercially available low-cost bony pelvis models and polyvinyl chloride (PVC) pipes as a foundation for the soft tissue inserts to attach. 12,13,[31][32][33] Each model varies on what it "teaches best" regarding realismfor example, teaching anatomy, working in a tight space, dissection, or clamp placement and suture ligature. Furthermore, since vaginal hysterectomy is a high-complexity procedure in terms of skills (working in confined space, limited view, "upsidedown" anatomy, and need to direct assistants for retraction and exposure), task breakdown is important for simulation learning, as it is not efficient to repeat the entire procedure until proficiency is reached.…”