Original ReportsIntegration and Validation of Hysteroscopy Simulation in the Surgical Training Curriculum
Introduction
Hysteroscopy is a minimally invasive technique for the assessment and treatment of intrauterine pathologies.1, 2 The development of new instruments and the introduction of fellowship programs for the training of residents in minimally invasive gynecological surgery have encouraged the usage and implementation of diagnostic and operative hysteroscopy in routine clinical practice.3, 4
In comparison with laparoscopy, hysteroscopic skills are often assumed to be less difficult to obtain.5 The teaching of hysteroscopic interventions has received little attention thus far, focusing mainly on the development of physical models and box simulators,6 while the demand for well-structured hysteroscopy training is expanding rapidly.7
Existing training models range from cow uteri and bladders to virtual reality; however, a Dutch survey revealed that lack of simulation training during residency was the leading factor that could be enhanced for optimal acquisition of hysteroscopic skills.7 This encouraged our working group to search for a suitable hysteroscopic simulator module and to test its validation.
With a widely accepted validation procedure yet to be established, we decided to follow the process suggested by researchers from the University of Switzerland in the evaluation of virtual reality simulators.8 The validation process is divided into the following 3 steps: face validation, defined as the extent to which the simulation resembles real-life simulation; construct validity, a set of evaluation procedures based on quality, ability, and traits it was designed to measure; and predictive validity, the extent to which the scores are predictive of actual performance.9
The primary objective of our study was to test the construct validity of the HystSim to determine whether simulation training improves the acquisition of hysteroscopic skills of the candidate independent of the previous level of experience by the use of a selected training scenario, applicable to contemporary practice. The secondary objective was to analyze the performance of a selected task using the scoring charts to reduce the learning curve for both novices and experienced surgeons.
Section snippets
Subjects
Between June 2014 and May 2015, our group collected data on 57 participants of minimally invasive surgical training programs at the Kiel School of Gynecological Surgery, Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. The participants were divided into the following 2 groups: a novice group consisting of 42 medical students and junior residents with less than 2 years of gynecological experience and no prior experience in hysteroscopy, and
Results
All participants showed significant improvements in the posttest relative to the pretest (p < 0.002), independent of their previous level of experience. Regarding the overall result, the expert group exhibited superior performances in the posttest with a mean score of 206.60 (97.21) and a significant difference between the pretest and posttests with a mean of 154.20 (148.34) points. Following the Rosenthal test, a good comparative quantitative effect between the 2 groups was demonstrated
Discussion
The aim of our study is to evaluate the construct validity of the hysteroscopic simulator HystSim to integrate hysteroscopy simulation into the training curriculum, and secondly to analyze the learning curves of novice and expert groups to accelerate the acquisition of operative skills.
We decided to use the HystSim as it is one of the few hysteroscopic simulators that has already passed through a face and construct validation process for a diagnostic exercise, establishing high ratings for both
Conclusion
Before future implementation of the HystSim simulator into the surgical training curriculum, we recommend an interval study at 6 months after training to evaluate whether the benefit of simulation training degrades over this time and whether simulation training may need to be repeated at more frequent intervals. Such investigations are required to confirm the marginal value of simulation training in daily practice and its predictive validity.
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Training of hysteroscopic skills in residency program: the Dutch experience
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Complications of uterine fibroids and their management, surgical management of fibroids, laparoscopy and hysteroscopy versus hysterectomy, haemorrhage, adhesions, and complications
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Cited by (25)
Surgical simulation supplements reproductive endocrinology and infertility fellowship training
2020, F and S ReportsCitation Excerpt :In gynecology, effective simulation models have been described for a variety of advanced procedures including laparoscopic ureteral dissection (19), vaginal hysterectomy (37), trans-vaginal tape placement (38), sacrospinous ligament fixation, and radical hysterectomy (29, 39). Use of brief, intensive surgical boot camps has been validated to prepare medical students for an OBGYN residency (40) and to reinforce basic procedural skills for junior residents (39, 41) but has yet to be described for advanced reproductive surgery. A key strength of this study is its wide reach, with representation from more than 70% of the REI fellowship programs in the country.
Essentials in Minimally Invasive Gynecology Manual Skills Pilot Validation Trial: EMIG Manual Skills Pilot Study
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2019, American Journal of Obstetrics and GynecologyHysteroscopic resection on virtual reality simulator: What do we measure?
2018, Journal of Gynecology Obstetrics and Human ReproductionCitation Excerpt :Developing optimal scoring methods based on these parameters is a major challenge [33,34]. The MMSS available on HystSim™ failed to separate novices from experts [27,28] for resection procedures on previous studies. Neis et al. [27] had tested 39 gynecologist, separated on a “basic group” (<10 operative hysteroscopy) and an “advanced group” (>10 operative hysteroscopy) on a polyp and a myoma resections on HystSim™.
Simulation for Training and Assessment in Hysteroscopy: A Systematic Review
2018, Journal of Minimally Invasive GynecologyCitation Excerpt :Feedback reports are available after each training session, independently of external examiners [22,28,29]. The effect of hysteroscopy simulation on learning was addressed by 13 prospective cohort studies [18,19,22–25,28,30,32,34–37]. No randomized control trial was identified.