A Needs Assessment To Enhance Vaginal Surgical Skills Through Simulation for Ghanaian Trainees

Objectives: Vaginal procedures are important core surgeries that Obstetricians and Gynecologists perform. Vaginal surgery requires a surgeon to operate in a highly constrained, three-dimensional space and requires different skills than abdominal or laparoscopic surgery. Vaginal surgery can be particularly important for the obstetrician and gynecologist who practices in a resource limited setting since vaginal surgery can often be performed with minimal equipment and personnel. We sought to assess trainee experience with vaginal surgery, confidence in vaginal surgical skills, and need for vaginal surgical simulation at a teaching hospital in Ghana.

Methods: A needs assessment survey was completed by 37 Ghanaian obstetrics and gynecology trainees, consisting of 18 junior residents, 9 senior residents, and 10 fellows. The 10-item survey targeted three domains including vaginal surgical experience, confidence, and need for simulation. Participant demographics were collected, including trainee year and subspecialization, when applicable. Vaginal surgeries were defined as any procedure performed primarily at or within the vaginal opening. Data were summarized using descriptive statistics.

Results: The majority of respondents (89%, 33/37) performed 0-50 vaginal surgeries in the last 12 months, with most reporting that the procedures they performed were perineal or cervical laceration repairs and cerclage placement (66%). Only 11% (4/37) performed vaginal hysterectomy, 11% (4/37) performed anterior or posterior colporrhaphy, 5% (2/37) performed vaginal apical suspensions, and 2% (1/37) performed a vaginal obliterative prolapse repair. Most participants reported high confidence in basic skills such as one-handed knot tying (58% (21/36), two-handed knot tying (69% (25/36) and running suturing (78% (28/36). However, only 38% of participants reported high confidence with Heaney transfixion pedicle ligation (14/36) and 44% for free pedicle ligation (16/36) (Figure 1). The majority of participants reported no confidence in performing vaginal hysterectomy (50%), anterior/posterior colporrhaphy (50-52%), vaginal apical suspension procedures (64%), or obliterative prolapse repairs (69%) (Figure 2). 94% of the participants reported that vaginal surgical simulation would be very important and useful for their training.

Conclusions: Trainees report that the majority of their vaginal surgical experience is with obstetric laceration repairs, with much less gynecologic surgical experience being reported. Trainees reported lower confidence with basic surgical skills required for gynecologic vaginal surgeries and no to low confidence with core gynecologic vaginal surgeries. Most participants reported vaginal surgical simulations would be very useful for their education. Vaginal surgical simulations may be an important modality for improving confidence in vaginal surgical skills in a Ghanaian training program.