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Implementation of Simulation Models into Migs Residency Curriculum
S20 Cooke CM,*,1 Flaxman T,2 Sheikh A,2,3 Althobaity W,3 Miguel O,4 Singh SS1,2. 1Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; 2Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada; 3Department of Radiology, University of Ottawa, Ottawa, ON, Canada; 4Ottawa-Carleton Institute of Biomedical Engineering, Ottawa, ON, Canada *Corresponding author. Study Objective: To evaluate the impact of 3-dimensional (3D) digital and printed models on minimally invasive gynecologic surgeons’ operative plan, outcomes, and experience. Design: Prospective, cross-sectional, repeated measures design. Setting: Pre-, intra-, and post-operative minimally invasive gynecologic surgery. Patients or Participants: Minimally Invasive Gynecology (MIG) surgeons (n=6) at The Ottawa Hospital (TOH) and their respective surgical cases (n=50). Interventions: Using our team’s 3D printing protocol, patient-specific 3D digital and printed models are produced from cross-sectional MR images. Surgeons complete a pre-operative questionnaire before and after viewing the models. They are given the opportunity to consult the models intraoperatively, and, finally, complete a post-operative questionnaire. Chisquare test of independences, Mann-Whitney U, and dependent T-tests will be used to evaluate significant differences between variables related to surgical plan before and after viewing models. Descriptive statistics will be used to evaluate surgeon experience. Measurements and Main Results: Two cases have been completed to date. The first was a proof of concept to establish our 3D printing and study protocols. In this case, a 3D model of a multifibroid uterus was printed for myomectomy planning in a 42-year-old G0P0 with bulk symptoms. In the second case, a 3D model was printed to plan for myomectomy in a 45-year-old G5P1 with future fertility goals. Viewing the 3D digital and printed model affected the surgeons’: planned hemostatic techniques, perceived surgical complexity, allocated operative time, anticipated risk of complications, confidence in surgical plan, and positively impacted their surgical experience. Conclusion: Patient-specific 3D models increase understanding of complex anatomy in gynecologic surgery, optimizing pre-operative planning, intra-operative performance, surgeon experience, and patient outcomes. Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM) 11:49 AM Overcoming Expert Blind Spot when Teaching the Novice Surgeon Foley CE,* Donnellan NM. Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, PA *Corresponding author. Video Objective: To demonstrate how expert blind spot impacts surgical teaching and provide concrete strategies to overcome this learning barrier. Setting: Academic teaching hospital. Interventions: This educational video deconstructs the steps required to teach and assist a novice surgeon during a total laparoscopic hysterectomy. Conclusion: Skilled surgical educators are able to overcome expert blind spot and deconstruct a procedure into steps appropriate for the learners’ skill level. Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM) 11:56 AM A Randomized Control Trial of Non-Surgical Methods of Non-Dominant Hand Training to Enhance Laparoscopic Skill
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Mui J,*,1 Choi SH,2 Rizzuto M.A.,2 Albert A,2 Mehra N1. 1Obstetrics & Gynecology, University of British Columbia, Vancouver, BC, Canada; 2 University of British Columbia, Vancouver, BC, Canada *Corresponding author. Study Objective: To determine if non-dominant hand training using taskspecific exercises or everyday activities, would translate to improved laparoscopic ambidexterity amongst medical trainees. Design: Single center non-blinded, randomized control trial. Setting: University medical school. Patients or Participants: Medical students. Interventions: 100 medical students were block randomized to receive either 1) Task-specific exercises to train the non-dominant hand, 2) Directions to use their non-dominant hand to perform everyday activities, or 3) No training. Laparoscopic skills during completion of pre-defined tasks were assessed using a box-trainer fitted with motion tracking equipment. Three time points were measured; pre-training, post-training (t = 3 weeks), and retention (t = 6 weeks). A principal components analysis incorporating extreme velocity and acceleration events was performed to assess multidimensional hand movements and obtain a global metric of ability i.e. smoothness of motion. We compared smoothness between groups and across times using mixed-effect linear regression, controlling for pre-test ability. Measurements and Main Results: There was a significant improvement in smoothness from the post-test phase to the retention phase for all groups (mean effect size d = 0.34), suggesting that smoothness was improving over time regardless of intervention. However, there was no difference in smoothness between the control group and either task-specific exercises or everyday activities for any task at any time point (all p > 0.05, mean task-specific effect size d = 0.14, mean everyday effect size d = 0.04). Conclusion: While sound in theory, training of the non-dominant hand to improve ambidexterity does not translate to the laparoscopic surgical environment. Simulation based laparoscopic exercises remain the favored education modality. Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM) 12:03 PM Implementation of Simulation Models into Migs Residency Curriculum Tam J,*,1 Tam T2. 1All For Women Healthcare, SC, Chicago, IL; 2OB/ Gyne, Rush University Medical Center, Chicago, IL *Corresponding author. Video Objective: Demonstrate the construction and implementation of three modified ACOG low-fidelity simulation models for minimally invasive gynecological surgery training of Obstetrics and Gynecology (OB/ Gyn) residents. Setting: OB/Gyn residency training program at an academic institution. Interventions: Three ACOG surgical simulation models for hysteroscopy, laparoscopic salpingostomy and salpingectomy for ectopic pregnancy, and laparoscopic ovarian cystectomy were constructed using low cost and readily available materials and supplies. Conclusion: Low fidelity simulation models can be easily implemented into an OB/Gyn residency curriculum to enhance residents’ procedural knowledge and skill development. Establishing a surgical simulation program provides a useful, practical, and effective training tool for teaching hysteroscopy and laparoscopic techniques. Developing a formal evaluation to ensure performance in the skills laboratory indeed translates to surgical competence in the operative room and would further enhance residency education and promote patient safety.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Mui J,*,1 Choi SH,2 Rizzuto M.A.,2 Albert A,2 Mehra N1. 1Obstetrics & Gynecology, University of British Columbia, Vancouver, BC, Canada; 2 University of British Columbia, Vancouver, BC, Canada *Corresponding author. Study Objective: To determine if non-dominant hand training using taskspecific exercises or everyday activities, would translate to improved laparoscopic ambidexterity amongst medical trainees. Design: Single center non-blinded, randomized control trial. Setting: University medical school. Patients or Participants: Medical students. Interventions: 100 medical students were block randomized to receive either 1) Task-specific exercises to train the non-dominant hand, 2) Directions to use their non-dominant hand to perform everyday activities, or 3) No training. Laparoscopic skills during completion of pre-defined tasks were assessed using a box-trainer fitted with motion tracking equipment. Three time points were measured; pre-training, post-training (t = 3 weeks), and retention (t = 6 weeks). A principal components analysis incorporating extreme velocity and acceleration events was performed to assess multidimensional hand movements and obtain a global metric of ability i.e. smoothness of motion. We compared smoothness between groups and across times using mixed-effect linear regression, controlling for pre-test ability. Measurements and Main Results: There was a significant improvement in smoothness from the post-test phase to the retention phase for all groups (mean effect size d = 0.34), suggesting that smoothness was improving over time regardless of intervention. However, there was no difference in smoothness between the control group and either task-specific exercises or everyday activities for any task at any time point (all p > 0.05, mean task-specific effect size d = 0.14, mean everyday effect size d = 0.04). Conclusion: While sound in theory, training of the non-dominant hand to improve ambidexterity does not translate to the laparoscopic surgical environment. Simulation based laparoscopic exercises remain the favored education modality. Open Communications 1: Basic Science/Research/Education (11:00 AM — 12:45 PM) 12:03 PM Implementation of Simulation Models into Migs Residency Curriculum Tam J,*,1 Tam T2. 1All For Women Healthcare, SC, Chicago, IL; 2OB/ Gyne, Rush University Medical Center, Chicago, IL *Corresponding author. Video Objective: Demonstrate the construction and implementation of three modified ACOG low-fidelity simulation models for minimally invasive gynecological surgery training of Obstetrics and Gynecology (OB/ Gyn) residents. Setting: OB/Gyn residency training program at an academic institution. Interventions: Three ACOG surgical simulation models for hysteroscopy, laparoscopic salpingostomy and salpingectomy for ectopic pregnancy, and laparoscopic ovarian cystectomy were constructed using low cost and readily available materials and supplies. Conclusion: Low fidelity simulation models can be easily implemented into an OB/Gyn residency curriculum to enhance residents’ procedural knowledge and skill development. Establishing a surgical simulation program provides a useful, practical, and effective training tool for teaching hysteroscopy and laparoscopic techniques. Developing a formal evaluation to ensure performance in the skills laboratory indeed translates to surgical competence in the operative room and would further enhance residency education and promote patient safety.