Livestream

Late-Breaking: Procedure-Specific Simulation for Vaginal Surgery Training: A Randomized Controlled Trial

Friday, October 6, 2023

8:18 AM – 8:22 AM US PST

Location: A105-106

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Presenting Author(s)

Roxana Geoffrion, MD

Associate Professor
University of British Columbia
Vancouver, British Columbia, Canada

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Co-Author(s)

NK

Nicole Koenig, BA

Research Coordinator/Manager
Department of Obstetrics and Gynecology, University of British Columbia
Vancouver, British Columbia, Canada
GC

Geoffrey Cundiff, MD

Professor
University of British Columbia
North Vancouver Northwest Central, British Columbia, Canada
CF

Cathy Flood, MD

Professor
University of Alberta
Edmonton, Alberta, Canada
MH

Momoe Hyakutake, MD (she/her/hers)

Associate Professor
University of Alberta
Edmonton, Alberta, Canada
JS

Jane Schulz, MD

Professor
University of Alberta
Edmonton, Alberta, Canada
TL

Terry Lee, PhD

Statistician
Centre for Health Evaluation and Outcome Sciences
Vancouver, British Columbia, Canada
JS

Joel Singer, PhD

Statistician
Centre for Health Evaluation and Outcome Sciences
Vancouver, British Columbia, Canada

Disclosure(s):

Roxana Geoffrion, MD: No financial relationships to disclose

Nicole Koenig, BA: No financial relationships to disclose

Geoffrey Cundiff, MD: Amara Therapeutics: Cheif Medical Officer, Co-founder (Ongoing)

Cathy Flood, MD: No financial relationships to disclose

Momoe Hyakutake, MD: No financial relationships to disclose

Jane Schulz, MD: Abbvie: Consultant/Advisory Board (Ongoing); Pfizer: speaker (Terminated, April 30, 2023)

Terry Lee, PhD: No financial relationships to disclose

Joel Singer, PhD: No financial relationships to disclose

Objectives: To investigate whether procedure-specific skills acquired in a surgical lab, compared to usual training, result in improved operative competence among junior gynecology residents performing supervised vaginal surgery.

Methods: In a randomized controlled trial, the intervention consisted of didactic and procedural training in a low fidelity simulation environment with three vaginal surgery models specific to anterior repair (AR), posterior repair (PR) and vaginal hysterectomy (VH) respectively. The primary outcome was performance as evaluated by attending staff blinded to group assessment, via global rating scale of surgical skill (GRS) in the real operating room and for corresponding procedures. Prespecified secondary outcomes included knowledge of procedural steps, overall impression of performance, resident satisfaction, self-confidence and intraoperative parameters of estimated blood loss, operative time and complications. A priori sample size calculation estimated 50 residents to find a 20% absolute difference in GRS score with 25% SD, 80% power and a significance level of 0.05.

Results: From 2012 to 2022, 83 residents were randomized to intervention or control groups and 55 completed the trial. All characteristics were similar between groups. The primary outcome analysis was adjusted for resident age, level and baseline knowledge. Adjusted GRS scores showed a significant group difference overall (mean difference 8.2; 95% CI 0.2,16.1; p=0.044) and for VH (mean difference 12.0; 95% CI 1.8, 22.3; p=0.02), but not for AR or PR. The intervention group also had significantly higher procedural steps knowledge, satisfaction and self-confidence for VH and PR (p < 0.05 for all). Estimated blood loss, operative time and complications were similar between groups.

Conclusions: Compared to usual training, surgical education modules using procedure-specific low fidelity models for vaginal surgery resulted in significant improvements in actual operative performance and several other skill parameters.