Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology?

Study ObjectiveTo determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty.DesignProspective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire.SettingOb/Gyn residency training programs without PAG faculty.ParticipantsOb/Gyn residents in training from February 2015 to June 2015.InterventionsExposure to the NASPAG Short Curriculum.Main Outcome MeasuresImprovement in self-perceived knowledge after completion of curriculum.ResultsTwo hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints.ConclusionSignificant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG.     

Correcting the Fundamentals of Laparoscopic Surgery “Illusion of Validity” in Laparoscopic Vaginal Cuff Suturing

Study ObjectiveThe “illusion of validity” is a cognitive bias in which the ability to interpret and predict surgical performance accurately is overestimated. To address this bias, we assessed participants comparing fundamentals of laparoscopic surgery (FLS) and non-FLS tasks with cadaveric vaginal cuff suturing to determine the most representative simulation task for laparoscopic vaginal cuff suturing.DesignValidity (Messick framework) study comparing FLS and non-FLS tasks with cadaveric vaginal cuff suturing.SettingSimulation center cadaver laboratory.ParticipantsObstetrics and gynecology residents (n = 21), minimally invasive gynecologic surgery fellows (n = 3), gynecologic surgical subspecialists (n = 4), general obstetrician/gynecologists (n = 10).InterventionsTasks included a simulated vaginal cuff (ipsilateral port placement), needle passage through a metal eyelet loop (contralateral and ipsilateral), and intracorporeal knot tying (contralateral and ipsilateral). Simulation task times were compared with the placement of the first cadaveric vaginal cuff suture time, as well as the in-person and blinded Global Operative Assessment of Laparoscopic Skills (GOALS) score (“relations to other variables” validity evidence). Statistical analyses included Spearman's test of correlation (continuous and ordinal variables) or Wilcoxon rank sum test (categoric variables).Measurements and Main ResultsThere was a stronger association with cadaver cuff suturing time for simulated vaginal cuff suturing time (r = 0.73, p <.001) compared with FLS intracorporeal contralateral suturing time (r = 0.54, p <.001). Additional measures associated with cadaveric performance included subspecialty training (median: 82 vs 185 seconds, p = .002), number of total laparoscopic hysterectomies (r = –0.53, p <.001), number of laparoscopic cuff closures (r = –0.61, p <.001), number of simulated laparoscopic suturing experiences (r = –0.51, p <.001), and eyelet contralateral time (r = 0.52, p <.001). Strong agreement between the in-person and blinded GOALS (intraclass correlation coefficient = 0.80) supports response process evidence. Correlations of cadaver cuff time with in-person (Spearman's r = –0.84, p <.001) and blinded GOALS (r = –0.76, p <.001) supports relations to other variables evidenceConclusionThe weaker correlation between FLS suturing and cadaver cuff suturing compared with a simulated vaginal cuff model may lead to an “illusion of validity” for assessment in gynecology. Since gynecology specific validity evidence has not been well established for FLS, we recommend prioritizing the use of a simulated vaginal cuff suturing assessment in addition to FLS.     

Barriers Preventing Medical Students From Performing Pelvic Examinations During Obstetrics and Gynaecology Clinical Clerkship Rotations

ObjectiveThis study sought to identify barriers that prevent medical students from performing pelvic examinations in their obstetrics and gynaecology (Ob/Gyn) clinical clerkship rotations and to compare the perspectives of faculty, residents, nurses, and students regarding perceived barriers.MethodsAn electronic survey was distributed to third-year Dalhousie University (Halifax, NS) medical students on completion of their Ob/Gyn clerkship rotations in the 2015-2016 academic year and to Ob/Gyn nursing staff, faculty, and residents (Canadian Task Force Classification III).ResultsThere were 82 responses, giving an overall response rate of 28%. Students reported performing an average of 9.2 speculum examinations, 3.8 cervical checks, and 2.8 bimanual examinations during their 6-week rotations. They reported being declined the opportunity to perform an examination an average of 7.1 times. Students perceived themselves to be more competent performing these examinations compared with staff perception of student competency. Students perceived resident interest in teaching, resident and staff time constraints, and patient willingness to have a medical student involved in their examination as frequent barriers. Faculty, residents, and nurses perceived student gender, patient willingness, difficulty of examination, and resident time constraints to be significant barriers.ConclusionThis study is the first to examine multidisciplinary perspectives on perceived barriers to medical students performing pelvic examinations. Staff and students have different perceptions of a student's competence performing these examinations. Existing barriers are likely multifactorial.     

Dealing with Female Sexuality: Training,Attitude, and Practice of Obstetrics and Gynecology Residents from a Developing Country

IntroductionThere is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy.AimThe aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality.MethodsA cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy.Main Outcome MeasuresTraining, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures.ResultsA total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients’ questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic.ConclusionThe vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents. Vieira TCSB, de Souza E, da Silva I, Torloni MR, Ribeiro MC, and Nakamura MU. Dealing with female sexuality: Training, attitude, and practice of obstetrics and gynecology residents from a developing country. J Sex Med 2015;12:1154–1157.     

Blinded Assessment of Operative Performance After Fundamentals of Laparoscopic Surgery in Gynecology Training

Study ObjectiveTo determine the pass rate for the Fundamentals of Laparoscopic Surgery (FLS) examination among senior gynecology residents and fellows and to find whether there is an association between FLS scores and previous laparoscopic experience as well as laparoscopic intraoperative (OR) skills assessment.DesignProspective cohort study (Canadian Task Force classification II-2).SettingThree gynecology residency training programs.ParticipantsThird- and fourth-year gynecology residents and urogynecology fellows.InterventionsAll participants participated in the FLS curriculum, written and manual skills examination, and completed a survey reporting baseline characteristics and opinions. Fourth-year residents and fellows underwent unblinded and blinded pre- and post-FLS OR assessments. Objective OR assessments of fourth-year residents after FLS were compared with those of fourth-year resident controls who were not FLS trained.Measurements and Main ResultsTwenty-nine participants were included. The overall pass rate was 76%. The pass rate for third- and fourth-year residents and fellows were 62%, 85%, and 100%, respectively. A trend toward improvement in OR assessments was observed for fourth-year residents and fellows for pre-FLS curriculum compared with post-FLS testing, and FLS-trained fourth-year residents compared with fourth-year resident controls; however, this did not reach statistical significance. Self-report of laparoscopic case load experience of >20 cases was the only baseline factor significantly associated with passing the FLS examination (p = .03).ConclusionThe FLS pass rate for senior residents and fellows was 76%, with higher pass rates associated with increasing levels of training and laparoscopic case experience.     

Resident education and training in female sexuality: results of a national survey

IntroductionConsidering the prevalence of female sexual dysfunction, the lack of education and training in female sexual function and dysfunction (FSF&;D) during and obstetrics and gynecology residency highlights a need for greater focus on this topic.AimTo assess understanding and confidence among third and fourth year Ob/Gyn residents with respect to FSF&;D.MethodsAn Internet‐based survey was constructed to evaluate third and fourth year residents in American Council for Graduate Medical Education‐approved Ob/Gyn programs. Residents were asked about familiarity, knowledge, and confidence in treating various aspects of FSF&;D, based on the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives for Ob/Gyn training. They were also queried regarding areas of improvement for their education.Main Outcome MeasureResponses to survey instrument.ResultsTwo hundred thirty‐four residents responded. The majority (91.5%) reported attending ≤5 didactic activities on FSF&;D. Only 19.6% reported often or always screening women for sexual function problems; most had very little or no knowledge in administering or interpreting screening questionnaires. While many (82.8%) felt confident about obtaining a complete sexual history, only 54.7% felt able to perform a targeted physical exam. Although most residents had cared for women with dyspareunia (55.1%), a minority had managed many women with low desire (18.4%), arousal problems (8.1%), anorgasmia (5.6%), or vaginismus (16.7%). In treating patients, 34–56% reported rarely or never suggesting ancillary therapy such as counseling and medications. However, the majority believed that their confidence would increase through FSF&;D lectures (97.9%), FSF&;D patient observations (97.4%), rotating with a urogynecologist (94.4%), and online modules (90.6%).ConclusionDespite CREOG requirements for Ob/Gyn training in female sexuality, most residents feel ill‐equipped to address these problems. Additional evidence‐based educational and didactic activities would enhance residents' knowledge and confidence in treating these common, quality‐of‐life issues. Pancholy AB, Goldenhar L, Fellner AN, Crisp C, Kleeman S, and Pauls R. Resident education and training in female sexuality: Results of a national survey.     

A Randomized Multicenter Study Assessing the Educational Impact of a Computerized Interactive Hysterectomy Trainer on Gynecology Residents

Study Objective

To assess the improvement of cognitive surgical knowledge of laparoscopic hysterectomy in postgraduate year (PGY) 1 and 2 gynecology residents who used an interactive computer-based Laparoscopic Hysterectomy Trainer (Red Llama, Inc., Seattle, WA).

Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents

OBJECTIVE: To examine the current state of basic and advanced gynecologic endoscopy teaching in Canadian Obstetrics and Gynecology (Ob/Gyn) residency programs. METHODS: On Institutional Research Board approval, 2 pretested anonymous questionnaires were developed: one distributed to all Canadian Ob/Gyn program directors and a second to graduating residents (Canadian Task Force classification III). Two mailings were sent to maximize response, and some department chairs received personal telephone calls by the senior author to encourage participation. Residents on maternity leave were excluded from the study. RESULTS: Fifteen of 16 (94%) program directors, and 47 of 62 (76%) residents participated. Directors expect all residents to be knowledgeable and competent performing basic endoscopic procedures on graduation. However, considerable variation exists among programs that teach advanced endoscopy. Some of the more important factors limiting integration of advanced endoscopic teaching include paucity of trained faculty, lack of attending interest, scarcity of operating time, and financial constraints. Most graduating residents consider undertaking additional gynecologic endoscopy fellowships. CONCLUSION: Most Ob/Gyn program directors and graduating residents consider endoscopic surgery essential to contemporary practice. There is consensus to improve resident teaching in gynecologic endoscopy and commitment to better prepare future practitioners to ensure patient safety. Paucity of trained faculty and fiscal constraints appear to be important limiting factors.     

Effect of a Surgical Teaching Video on Resident Performance of a Laparoscopic Salpingo-oophorectomy: A Randomized Controlled Trial

Study ObjectiveTo assess the effect of a surgical teaching video on junior resident knowledge and performance of a laparoscopic salpingo-oophorectomy (LSO).DesignRandomized controlled trial.SettingUrban tertiary care academic obstetrics and gynecology department.PatientsFirst- and second-year gynecology residents.InterventionsAccess to an education video on LSO for 1 week before performing this surgery in the operating room.Measurements and Main ResultsTwenty-four junior residents were recruited and randomized to either the educational video group or traditional residency training group. All participants completed a demographic survey and knowledge questionnaire before performing an LSO, which was video-recorded. Video recordings of surgical performance were analyzed using the Objective Structured Assessment of Technical Skills (OSATS; 20 points) and an LSO-specific tool (30 points). Participants completed a self-assessment questionnaire before completing the procedure. The primary outcome measure was the difference in OSATS scores. The secondary outcomes were the knowledge questionnaire scores and self-assessed confidence scores. There were no significant differences between demographic variables of the 2 groups. The primary outcome revealed no significant differences in mean (standard deviation) OSATS scores (10.64 [2.05] vs 11.55 [1.85], p = .3) or LSO-specific tool scores (16.45 [2.68] vs 17.85 [2.63], p = .24). However, there was a significant difference in mean knowledge scores between the video and the traditional training (8.42 [0.79] vs 7.11 [1.36], p = .01) groups. In addition, residents in the video group had more confidence in their knowledge of pelvic anatomy (3.83 [0.39] vs 3.00 [1.00] out of 5.00, p = .04).ConclusionFor junior learners, the use of an LSO video improved knowledge and confidence in anatomy but did not translate to improved surgical performance in the operating room. Surgical videos are a useful adjunct and complement hands-on technical teaching.     

Development and Validation of Simulation Training for Vaginal Hysterectomy

Study ObjectiveTo develop and validate an educational intervention based on vaginal hysterectomy (VH) simulation.DesignProspective cohort study (Canadian Task Force classification II-2).SettingSurgical skills simulation center.PatientsThirty residents in Obstetrics and Gynecology (11 PGY-2, 11 PGY-3, and 8 PGY-4).InterventionVH educational intervention that included a lecture, a video, and surgical skill simulation using a new inexpensive model.Measurements and Main ResultsThe primary outcome was written test scores before and after the educational intervention, and the secondary outcome was self-rated confidence in performing VH. Baseline written scores were similar for all 3 training levels; however, baseline confidence scores were higher for PGY-3 and PGY-4 residents than for PGY-2 residents (p < .01). After the workshop, written test scores improved significantly for all trainees (median [range] improvement, 4 [3.5–5.0] points; p < .01). Mean (SD) improvement in confidence scores for PGY-4, PGY-3, and PGY-2 residents was 0 (0.5), 0.5 (0.8), and 1 (1.3), respectively, with improvement in confidence scores reaching significance only for PGY-2 residents (p < .02). All trainees expressed high satisfaction with the workshop.ConclusionAn educational intervention based on VH simulation is feasible and improves knowledge and confidence in junior residents with limited exposure to VH.     

Use of Fundamentals of Laparoscopic Surgery Testing to Assess Gynecologic Surgeons: A Retrospective Cohort Study of 10-Years Experience

Study ObjectiveTo compare the Fundamentals of Laparoscopic Surgery (FLS) exam scores between obstetrics and gynecology (OBGYN) and general surgery (GS) providers.DesignThis is a retrospective cohort study at a single institution from July 2007 to May 2018. Categorical and continuous variables were analyzed with χ2 test, t test, and Wilcoxon rank sum test.SettingBeth Israel Deaconess Medical Center (BIDMC), Boston, MA, a tertiary care academic medical center.PatientsAll providers who took the FLS exam at the Carl J. Shapiro Simulation and Skills Center at BIDMC.InterventionsFLS certification.Measurements and Main ResultsA total of 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018, of which 176 were identified to be OBGYN or GS providers. The FLS certification pass rate was high for both specialties (97.0% OBGYN vs 96.1% sGS, p = .76). When comparing all providers, no significant difference was found in the mean manual skill test scores between surgical specialties (594.9 OBGYN vs 601.0 GS, p = .59); whereas, a significant difference was noted in the mean cognitive scores, with GS providers scoring higher than OBGYN providers (533.8 OBGYN vs 583.4 GS, p <.001). However, when adjusting for several variables in a multivariate linear regression model, surgical specialty was not a predictor for cognitive scores. In the multivariate analysis, age, sex, and test year were predictors for cognitive scores, with higher scores associated with younger age, male sex, and advancing calendar year. None of the variables were significant predictors of manual scores.ConclusionBoth OBGYN and GS providers had extremely high FLS pass rates. In the multivariate analysis, surgical specialty was not a predictor for higher FLS test scores for either manual or cognitive test scores. Although OBGYN residency programs offer fewer years of training, OBGYN trainees demonstrate the capacity to perform well on the FLS exam.     

Use of the Limbs and Things Hysterectomy Model to Describe the Process for Establishing Validity

Study Objective

To demonstrate the process for establishing or refuting validity for the Limbs and Things hysterectomy model.

A Low-fidelity Model for Office-based Hysteroscopy with a Vaginoscopic Approach

Study ObjectiveHysteroscopy is an established method for the diagnosis and treatment of intrauterine pathology. A vaginoscopic approach for office-based hysteroscopy confers less pain; however, trainees report lack of confidence with this procedure. We sought to create a low-fidelity simulation model for office-based hysteroscopy with a vaginoscopic approach and to evaluate the validity and reliability of this model.DesignProspective cohort study.SettingA single academic medical center.ParticipantsEligible participants included obstetrics and gynecology residents and attendings who regularly perform hysteroscopy.InterventionsThe vaginoscopy model was created with an inanimate female pelvis simulator with an exam glove placed within the vagina. Following 2 instructional videos, participants performed a hysteroscopy simulation with a vaginoscopic approach. The primary outcome was total score on a modified Global Rating Scale and Objective Structured Assessment of Technical Skills. The Objective Structured Assessment of Technical Skills outlines a series of steps that must be performed and was created with assistance from experts in hysteroscopy for providing content-oriented evidence of validity. Time to complete each task and total time were tracked. Participants completed a postprocedure survey assessing the model and experience.Measurements and Main ResultsA total of 30 physicians participated, with 20 residents (9 junior and 11 senior) and 10 attendings. Attending physicians completed the simulation faster than junior residents (197.2 ± 30.9 vs 289.8 ± 107.4 seconds, p = .022). On the Global Rating Scale, both attending physicians and senior residents scored significantly higher than junior residents (26.1 ± 2.4 vs 22.5 ± 3.7, p = .01). Postsurvey data demonstrated that 93.3% of all participants were satisfied with simulation, 96.6% found it useful, 80% found it realistic, and 93% indicated that they may use this technique in the future.ConclusionThis study shows our low-fidelity model to be effective and useful and to improve confidence for vaginoscopic approach to hysteroscopy. Further studies are needed to assess ability to predict or improve clinical and surgical skills.     

Sexual Functioning of Latino Women Seeking Outpatient Gynecologic Care

IntroductionA sample of Latino women from an ambulatory obstetrics and gynecology (Ob/Gyn) clinic were queried about their sexual functioning using the Changes in Sexual Functioning Questionnaire (CSFQ-14).AimTo assess the degree of self-reported sexual complaints in a sample of Latino women living in the United States; to assess if the prevalence of symptoms differs from one study of women living in Spain; and to determine if sexual complaints were associated with demographics, sexual/reproductive history, selected medications, or religious practices.Main Outcome MeasuresCSFQ-14 scores and demographic variables.MethodsCSFQ-14 questionnaire in an out-patient, bilingual Ob/Gyn clinic in Central Virginia.ResultsSeventy-one native Spanish-speaking patients (59% born in Mexico) completed the U.S. Spanish version of the CSFQ-14 and a short questionnaire for potential covariates. The mean age was 28.7 years (range 17–60). Birth place was outside of the United States for 95.8% (N = 67). Eighty percent of participants had children and 96% reported being currently sexually active. Low sexual functioning, as defined by a total CSFQ score of ≤41, was found in 26 (41.3%) participants. Taking medication for depression and/or anxiety was associated with lower sexual functioning (P = 0.03). Women who had children of any age living in the household were less likely to report low sexual functioning (P = 0.05; P = 0.01 when restricted to infants) than women without children living in the household. Thirteen of 68 women (19.1%) reported a history of physical and/or sexual abuse, but this was not associated with low sexual functioning. There was no association between self-reported religious affiliation or church attendance frequency and sexual complaints. Respondents in our sample had lower (i.e., worse sexual function) overall CSFQ scores compared with a sample of college students in Spain (P < 0.01), but higher (i.e., better sexual function) overall scores than workers in Spain (P < 0.04). On the subscales, our Latino population reported greater pleasure and less desire/interest than women who live in Spain.ConclusionsSelf-reported rates of low sexual functioning were common in this cross section of Latino women. Medical treatment of depression and/or anxiety was associated with lower functioning. Direct inquiry about the sexual health of U.S. Latino women presenting for routine health care may assist in the identification of sexual difficulties in this population. Hullfish KL, Pastore LM, Mormon AJA, Wernecke Y, Bovbjerg VE, and Clayton AH. Sexual functioning of Latino women seeking outpatient gynecologic care.     

Pilot study evaluating a 12-h mindfulness-based curriculum for OB/GYN residents

ObjectivesThis prospective cohort study assessed the impact of a 12-h mindfulness-based wellness curriculum on OB-GYN residents’ burnout, mindfulness, and self-compassion.MethodsFourteen 1st year OB-GYN residents at the University of California, Irvine (n = 7 in two separate cohorts) were eligible and participated in a 12-h, in-person wellness curriculum between January 2017 and May 2018 emphasizing meditation training, present moment emotional awareness, and self-compassion. The curriculum included didactic and experiential components and home-based exercises. Participants were assessed before starting the curriculum (T1), after finishing the curriculum (T2), and 6-9-months later (T3) using the Maslach Burnout Inventory (MBI), the Five Facet Mindfulness Questionnaire (FFMQ), and the Self-Compassion Scale (SCS).ResultsFourteen residents (100%) completed the survey at T1, 13 residents (93%) completed the survey at T2, and 12 residents (86%) completed the survey at T3. Levels of burnout did not change significantly. Overall mindfulness increased from T1 to T3 (p < .05), as did non-judging inner experiences (p < .01). Overall levels of self-compassion increased from T1 to T3 (p < .05), with self-kindness and self-judgment improving from T1 to T3 (both p < .05). The vast majority of improvements were evident at the 6-9-month follow-up.ConclusionsThis study provides preliminary support that a mindfulness-based wellness curriculum may improve overall levels of mindfulness and self-compassion in 1st year OB-GYN residents.     

Correlation of Virtual Reality Simulation and Dry Lab Robotic Technical Skills

Study Objective

To examine whether a set of virtual reality (VR) surgical simulation drills have correlative validity when compared with the validated Robotic Objective Structured Assessment of Technical Skills (R-OSATS) dry lab drills.

Validation of Transvaginal Hysterectomy Surgical Model – Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation

Study ObjectiveTo establish face and construct validity for a novel variation of American College of Obstetrics and Gynecology “Flowerpot Model” for transvaginal hysterectomy (TVH) surgical simulation with improved vesicovaginal dissection during surgical education simulation.DesignCross-sectional face and construct validation study using the “Flowerpot Model.” The vesicovaginal dissection plane was modified to include additional felt and balloon materials to simulate the bladder.SettingSingle academic center.ParticipantsFourteen residents and fellows, postgraduate year (PGY) 2 to 6, subdivided into junior (n = 8) with ≤10 prior TVH surgeries and senior groups (n = 6) with >10 prior TVH surgeries performed.InterventionsAll subjects watched a brief introductory video and then were filmed simulating a TVH.Measurements and Main ResultsFor face validity, subjects completed an anatomic checklist and pre/post simulation satisfaction survey. For construct validation, 2 independent, blinded expert surgeons (M.A. and J.M.) graded films using the Global Rating Scale of Operative Performance (GRS). Primary outcome was mean GRS between groups.The junior group consisted of PGY 2 to 3 with ≤ 10 prior TVH, median 7.5 (interquartile range [IQR] 6.75) and senior group PGY 3 to 6 with >10 TVH, median 19 (IQR 10) (p <.01). Subjects were “satisfied” or “very satisfied” with bladder and anterior peritoneal fold simulation (92%) and found vesicovaginal dissection “realistic” (100%). GRS score was significantly different between groups (juniors, 19.5 [IQR 5] vs seniors, 28.5 [IQR 8.5]; p = .048). Intergrader correlation was high (ρ = 0.87, p <.01). Surgeon volume of prior TVH was not significantly correlated to average GRS score, ρ = 0.49 (p = .10). The model improved comfort and confidence scores in the junior group more than senior group (p = .04), but senior group still had higher post simulation confidence scores than the junior group (p = .02).ConclusionFace and construct validity with the modified Flowerpot Model was demonstrated. This low fidelity model is capable of simulation of a TVH with a novel vesicovaginal dissection. Prior surgical experience was not correlated to GRS score or time to procedure completion.     

To treat or not to treat: perceptions of the initial American Society for Reproductive Medicine COVID-19 recommendations among women’s health providers

PurposeThe objective of this study was to evaluate the perception of the initial ASRM COVID-19 recommendations for infertility treatment held by women’s health providers within varying subspecialties, as well as their attitudes toward pregnancy and fertility during this time.MethodsAn electronic survey was sent to all women’s healthcare providers, including physicians, mid-level providers and nurses, in all subspecialties of obstetrics and gynaecology (Ob/Gyn) at a large tertiary care university-affiliated hospital.ResultsOf the 278 eligible providers, the survey response rate was 45% (n = 127). Participants represented 8 Ob/Gyn subspecialties and all professional levels. Participants age 18–30 years were significantly more likely to feel that women should have access to infertility treatment despite the burden level of COVID-19 in respective community/states (p = 0.0058). Participants within the subspecialties of general Ob/Gyn, maternal foetal medicine and gynecologic oncology were significantly more likely to disagree that all women should refrain from planned conception during the COVID-19 pandemic, in comparison to those in urogynecology and reproductive endocrinology and infertility (p = 0.0003).ConclusionsConsidering the immediate and unknown long-term impact of the COVID-19 pandemic on fertility care delivery, a better understanding of perceptions regarding infertility management during this time is important. Our study shows overall support for the initial ASRM recommendations, representing a wide spectrum of women’s health providers.     

Ergonomic Assessment of Surgeon Characteristics and Laparoscopic Device Strain in Gynecologic Surgery

Study ObjectiveTo evaluate whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with laparoscopic advanced energy devices.DesignProspective cohort study.SettingErgonomic simulation at an academic tertiary care site and the Society of Gynecologic Surgeons 47th Annual Meeting.PatientsThirty-eight participants (19 women and 19 men) were recruited.InterventionsSurgeon anthropometric measurements were collected. Each participant completed a 120-second trial of maximum voluntary effort with 3 laparoscopic advanced energy devices (LigaSure, HALO PKS, and ENSEAL). Grip strength was measured using a handheld dynamometer. Subjects completed the NASA Raw Task Load Index scale after each device trial. Grip strengths and ergonomic workload scores were compared using Student t tests and Wilcoxon rank sum tests where appropriate. Univariate and multivariate models analyzed hand size and ergonomic workload.Measurements and Main ResultsWomen had lower baseline grip strength (288 vs 451 N) than men, as did participants with glove size <7 compared with ≥7 (231 vs 397 N). Normalized grip strength was not associated with surgeon sex (p = .08), whereas it was significantly associated with surgeon glove size (p <.01). Grip strength decline was significantly greater for smaller compared to larger handed surgeons for LigaSure (p = .02) and HALO PKS devices (p <.01). The ergonomic workload of device use was significantly greater for smaller compared to larger handed surgeons (p <.01). Surgeon handspan significantly predicted grip strength decline with device use, even after accounting for potential confounders (R² = .23, β = .8, p <.01).ConclusionSurgeons with smaller hand size experienced a greater grip strength decline and greater ergonomic workload during repetitive laparoscopic device use. No relationship was found between surgeon sex and grip strength decline or ergonomic workload. Laparoscopic device type was also identified as a significant main effect contributing to grip strength decline. These findings point toward ergonomic strain stemming from an improper fit between the laparoscopic device and the surgeon's hand during device use.     

Modular Comparison of Laparoscopic and Robotic Simulation Platforms in Residency Training: A Randomized Trial

Study ObjectiveTo compare minimally invasive surgery (MIS) skills acquired using laparoscopic and robotic simulation training platforms.DesignRandomized trial (Canadian Task Force classification I).SettingUniversity residency training program.SubjectsPGY1 and PGY2 resident physicians in Obstetrics and Gynecology.InterventionsAll residents completed prestudy questionnaires (demographic data and previous experience in MIS) followed by simulation pretesting to assess baseline laparoscopic and robotic skills. Residents were then randomized to laparoscopic or robotic training cohorts in which they completed proctored training of 4 basic laparoscopic or 4 matching robotic modules (1 hour per module, 4 hours total). Thereafter, residents repeated the timed assessment of all skills. Finally, they completed poststudy questionnaires about the training experience. The primary outcome measure was the percentage of improvement in skill completion time. Secondary outcome measures were answers to poststudy questionnaires.Measurements and Main ResultsSixteen residents completed the study. The laparoscopic and robotic training groups did not differ substantially on demographic measures, previous experience in MIS, or baseline laparoscopic and robotic completion times. Median improvement for individual laparoscopic modules was, respectively, 37.76%, 46.43%, 53.29%, and 66.48% in the laparoscopic cohort vs 21.84%, 21.80%, 38.15%, and 32.98% in the robotic cohort. Median improvement for individual robotic modules was, respectively, 35.42%, 26.08%, 22.33%, and 47.48% in the laparoscopic cohort vs 52.70%, 62.02%, 67.64%, and 71.62% in the robotic cohort. Median improvement in combined laparoscopic, robotic, and overall skills was, respectively, 50.56%, 34.83%, and 45.52% in the laparoscopic group vs 36.18%, 64.12%, and 49.86% in the robotic group. Residents predicted greater comfort performing surgical procedures using the platform in which they trained; however, the robotic training cohort liked their training more.ConclusionsLaparoscopic and robotic simulation platforms each demonstrated improved performance in the same and other platform. The robotic platform seems to have an edge over the laparoscopic platform. Larger studies are required in addition to studies to compare the effectiveness of both platforms in more advanced skills and to compare their effect on proficiency in the operating room.