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Gyn Resident Needs for a Minimally Invasive Gynecologic Simulation Curriculum: A Focus Group Study
S188
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201
Table 1. Simulation Training for Specific Modes of Surgery Mode of Surgery
Our program needs simulation training in Faculty (N = 134) Trainee (N = 12)
Our program provides simulation training in Faculty (N = 134) Trainee (N = 12)
Laparotomy Vaginal surgery Conventional laparoscopic surgery Hysteroscopy Robotic surgery None of the above
59.0 50.0 27.6 26.1 20.2 25.0
38.1 35.8 74.6 57.5 59.0 N/A
41.7 64.2 25.0 25.0 25.0 14.9
16.7 33.3 58.3 41.7 33.3 N/A
Data presented as percentages.
Table 2. Faculty Opinion on When Average Trainee is Ready to Perform Surgery Independently Mode of Surgery
Robotic surgery (n = 119) Vaginal surgery (n = 120) Laparotomy (n = 121) Conventional laparoscopic surgery (n = 121) Hysteroscopy (n = 121)
Percentage (Cumulative Percentage) PGY 1 PGY 2 PGY 3
PGY 4
Requires additional training after residency
0.0 0.8 10.7 7.4 26.5
49.6 (73.2) 60.8 (93.3) 22.3 (97.4) 22.3 (98.3) 2.5 (98.4)
26.9 (100) 6.7 (100) 2.5 (100) 1.7 (100) 1.7 (100)
1.7 (1.7) 4.2 (5.0) 28.9 (39.6) 27.3 (34.7) 47.1 (73.6)
21.9 (23.6) 27.5 (32.5) 35.5 (75.1) 41.3 (76.0) 22.3 (95.9)
Data presented as percentages.
simulation training tools (88.4%), dedicated time (83.6%), simulation lab (80.5%), and simulation teaching faculty (61.7%) were most available, whereas FLS certification (24.0%) and MIGS division (42.6%) were least available. Both faculty and trainees reported laparotomy and vaginal surgery as the two modes of incision needing more simulation training, while laparoscopy and hysteroscopy simulation training were most commonly available. Table 1 lists reported simulation training needs and availability for specific modes of surgery. The majority of faculty reported residents were ready to perform laparotomies, laparoscopies, and hysteroscopies independently by their third year, but not vaginal surgery or robotic surgery. Table 2 presents the cumulative percentage for when faculty respondents feel the average trainee is ready to perform procedures independently. Conclusion: The majority of Ob/Gyn training programs report residents have access to simulation training resources such as simulation curricula, teaching faculty, training tools and simulation labs. Both faculty and trainees identify a need for simulation training in laparotomy and vaginal surgery.
576
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION F
Anatomical Remarks to Laparoscopic Hysterectomy Independelly of Uterus Size Souza CA, Genro VK, Dullius TP, Bessow CK, Cunha Filho JS. Serviço de Ginecologia e Obstetricia, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil This video explain anatomical remarks useful to guide surgical training of laparoscopy hysterectomy. We use common anatomical points that are reproductible in all patients independelly of uterus size. We use only reusable material and the major point of this video is the possibility of this kind of technique be done on development places.
577
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION G
Assessing Ob/Gyn Resident Needs for a Minimally Invasive Gynecologic Simulation Curriculum: A Focus Group Study Makhijani R,1 Clark M,2 Wohlrab K1. 1Department of Ob/Gyn, Warren Alpert School of Medicine of Brown University, Women & Infants Hospital, Providence, Rhode Island; 2Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts Study Objective: To obtain resident feedback to guide the development of a MIGS curriculum that is tailored according to resident needs and can be practically incorporated into Ob/Gyn residency training. Design: Focus Group Study. Setting: Academic-based residency program. Patients: Eight Ob/Gyn residents (2 from each postgraduate year) who were randomly chosen from a cohort of 32 residents from a single academic residency program. Intervention: The focus group had two parts. The first part employed a card sort format in which residents were asked to organize a set of cards prelabeled with different gynecologic surgery skills by educational priority. In the second part, residents were asked questions to explore the attitudes and opinions of the participants regarding a MIGS curriculum. Descriptive statistics were used to describe the demographic characteristics of our population. Themes were generated from notes taken during the focus group. The final transcript was examined based on an analytic induction method for focus group research. Measurements and Main Results: Laparoscopic suturing and managing intraoperative laparoscopic complications were the highest priority skills across postgraduate years. The lowest priority skills were peg transfer and nonlaparoscopic suturing. Participants highlighted a need for a structured curriculum. They emphasized that skills learned during simulation would more likely be retained if they were simulated closer to when they would
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 be performed on a clinical rotation. Lastly, they believed that simulation was most valuable when combined with one-on-one instruction. Conclusion: Residents from different levels of training expressed similar needs for a MIGS curriculum. For a MIGS curriculum to succeed, simulation time needs to be built into existing clinical rotations. To improve knowledge retention, skills specific to a rotation should be simulated close to when they will be performed. There needs to be a mechanism for resident accountability and real time feedback.
578
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION H
Broadening the Scope of Surgical Simulation Dubin AK, Smith R. Nicholson Center, Florida Hospital, Celebration, Florida Study Objective: To identify new areas for surgical simulation to greatly improve clinician and support staff readiness for the OR. Design: Laparoscopic and robotic surgeries have led to the creation of multiple simulators to train skills needed by surgeons. All of these devices have followed the same path in addressing, almost exclusively, the psychomotor skills required by new surgeons. The devices have not leveraged the power of the computers, imagery, and other VR devices to represent and teach the entire process of preparing for and conducting a surgical procedure. We explore the broader applications of these technologies that are available now but which are not being exploited by the surgical simulation industry. Setting: Surgical education for surgeons, residents, medical students, surgical support staff. Patients: n/a. Intervention: We identified eight areas of surgery that the simulation world has the potential to address: surgical skills, surgical procedures, robot “buttonology”, planning process, imagery analysis and selection, room and patient placement, equipment and table layout, and complications and recovery.
579
S189
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:15 PM – STATION A
Can We Trust Simulator Performance Assessment? It Depends. Comparing Robotic Simulator Metrics Vs. GEARS on Simple Virtual Reality Exercises Dubin AK,1 Julian D,1 Tanaka ADS,1 Smith R,1 Mattingly PJ2. 1Nicholson Center, Florida Hospital, Celebration, Florida; 2Obstetrics and Gynecology, Columbia University, New York, New York Study Objective: Current surgical education relies heavily upon simulation and several assessment tools are available to the trainee including robotic simulator assessment metrics and the Global Evaluative Assessment of Robotic Skills (GEARS) metrics, both of which have been independently validated. GEARS is a rating scale through which human evaluators score trainees’ recorded performances. We used two common robotic simulators, the dV-Trainer (dVT) and the da Vinci Skills Simulator (dVSS), to compare the performance metrics of robotic surgical simulators to GEARS scores for a basic robotic task. Design: Prospective single-blinded randomized study. Setting: Surgical education and training center. Patients: Surgeons and surgeons in training. Intervention: Subjects performed two trials of Ring and Rail 1 (RR1) on each of two simulators (DV-SS and DVT) after undergoing randomization and warm-up exercises. The second RR1 trial simulator performance was recorded and the de-identified videos were sent to human reviewers who scored them using GEARS. Eight pairs of simulator assessment metrics and GEARS metrics were identified based on expert knowledge. Paired Metrics from Different Scoring Systems 1 2 3 4 5 6 7 8
GEARS Depth Perception Efficiency Efficiency Bimanual Dexterity Bimanual Dexterity Robotic Control Total Score Total Score
Simulator Metric Economy of Motion Master Workspace Range Time to Complete Economy of Motion Master Workspace Range Instrument Collisions Time to Complete Overall Score
A Spearman’s rho calculated for their level of correlation. Measurements and Main Results: 74 subjects were enrolled with 10 subjects excluded for incomplete data. There was a strong correlation between GEARS score and simulator metric score in Time to Complete vs Efficiency, Time to Complete vs Total Score, Economy of Motion vs Depth Perception, Total Score vs Overall Score (rho coefficients ≤-0.70). Those with weak correlation (rho ≥-0.30) were Bimanual Dexterity vs. Economy of Motion, Effeciency vs. Master Workspace Range, Bimanual Dexterity vs. Master Workspace Range, and Robotic control vs. Instrument Collisions. GEARS
Simulator Exercise
Rho*
p
Efficiency
DVSS- Time to Complete DVT- Time to Complete DVSS- Time to Complete DVT- Time to Complete DVSS- Economy of Motion DVT- Economy of Motion DVSS- Overall Score DVT-Overall Score DVSS-Economy of Motion DVT- Economy of Motion DVSS- Master Workspace Range DVT- Master Workspace Range DVSS-Master Workspace Range DVT- Master Workspace Range DVSS- Instrument Collisions DVT- Instrument Collisions
−0.81 −0.91 −0.83 −0.83 −0.78 −0.81 −0.69 −0.69 −0.31 −0.31 −0.24 −0.11 −0.21 −0.20 −0.28 −0.32
<.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 .0149 .0114 .0637 .3846 .1085 .1104 .0280 .0108
Total Score Measurements and Main Results: Generic surgical skills have been the main focus of surgical simulation and these devices are just beginning to include actual surgical procedures with representations of human tissue. They could also include robotic “buttonology” to teach a user how to operate the various controls of a robotic device; imagery analysis (MRI, US, CT) and surgical planning before a complicated procedure; proper patient preparation and placement in the OR; and appropriate responses to complications and emergencies. Conclusion: This analysis explored the capabilities of modern computers, tools, and VR systems to model important aspects of surgery beyond basic hand-eye skills which are predominant today. These already possess the power to represent and train a much larger set of situations that are important to a successful surgical procedure. It is time to expect more from the developers of these simulation systems.
Depth Perception Total Score Bimanual Dexterity Efficiency Bimanual Dexterity Robotic Control
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201
Table 1. Simulation Training for Specific Modes of Surgery Mode of Surgery
Our program needs simulation training in Faculty (N = 134) Trainee (N = 12)
Our program provides simulation training in Faculty (N = 134) Trainee (N = 12)
Laparotomy Vaginal surgery Conventional laparoscopic surgery Hysteroscopy Robotic surgery None of the above
59.0 50.0 27.6 26.1 20.2 25.0
38.1 35.8 74.6 57.5 59.0 N/A
41.7 64.2 25.0 25.0 25.0 14.9
16.7 33.3 58.3 41.7 33.3 N/A
Data presented as percentages.
Table 2. Faculty Opinion on When Average Trainee is Ready to Perform Surgery Independently Mode of Surgery
Robotic surgery (n = 119) Vaginal surgery (n = 120) Laparotomy (n = 121) Conventional laparoscopic surgery (n = 121) Hysteroscopy (n = 121)
Percentage (Cumulative Percentage) PGY 1 PGY 2 PGY 3
PGY 4
Requires additional training after residency
0.0 0.8 10.7 7.4 26.5
49.6 (73.2) 60.8 (93.3) 22.3 (97.4) 22.3 (98.3) 2.5 (98.4)
26.9 (100) 6.7 (100) 2.5 (100) 1.7 (100) 1.7 (100)
1.7 (1.7) 4.2 (5.0) 28.9 (39.6) 27.3 (34.7) 47.1 (73.6)
21.9 (23.6) 27.5 (32.5) 35.5 (75.1) 41.3 (76.0) 22.3 (95.9)
Data presented as percentages.
simulation training tools (88.4%), dedicated time (83.6%), simulation lab (80.5%), and simulation teaching faculty (61.7%) were most available, whereas FLS certification (24.0%) and MIGS division (42.6%) were least available. Both faculty and trainees reported laparotomy and vaginal surgery as the two modes of incision needing more simulation training, while laparoscopy and hysteroscopy simulation training were most commonly available. Table 1 lists reported simulation training needs and availability for specific modes of surgery. The majority of faculty reported residents were ready to perform laparotomies, laparoscopies, and hysteroscopies independently by their third year, but not vaginal surgery or robotic surgery. Table 2 presents the cumulative percentage for when faculty respondents feel the average trainee is ready to perform procedures independently. Conclusion: The majority of Ob/Gyn training programs report residents have access to simulation training resources such as simulation curricula, teaching faculty, training tools and simulation labs. Both faculty and trainees identify a need for simulation training in laparotomy and vaginal surgery.
576
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION F
Anatomical Remarks to Laparoscopic Hysterectomy Independelly of Uterus Size Souza CA, Genro VK, Dullius TP, Bessow CK, Cunha Filho JS. Serviço de Ginecologia e Obstetricia, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil This video explain anatomical remarks useful to guide surgical training of laparoscopy hysterectomy. We use common anatomical points that are reproductible in all patients independelly of uterus size. We use only reusable material and the major point of this video is the possibility of this kind of technique be done on development places.
577
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION G
Assessing Ob/Gyn Resident Needs for a Minimally Invasive Gynecologic Simulation Curriculum: A Focus Group Study Makhijani R,1 Clark M,2 Wohlrab K1. 1Department of Ob/Gyn, Warren Alpert School of Medicine of Brown University, Women & Infants Hospital, Providence, Rhode Island; 2Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts Study Objective: To obtain resident feedback to guide the development of a MIGS curriculum that is tailored according to resident needs and can be practically incorporated into Ob/Gyn residency training. Design: Focus Group Study. Setting: Academic-based residency program. Patients: Eight Ob/Gyn residents (2 from each postgraduate year) who were randomly chosen from a cohort of 32 residents from a single academic residency program. Intervention: The focus group had two parts. The first part employed a card sort format in which residents were asked to organize a set of cards prelabeled with different gynecologic surgery skills by educational priority. In the second part, residents were asked questions to explore the attitudes and opinions of the participants regarding a MIGS curriculum. Descriptive statistics were used to describe the demographic characteristics of our population. Themes were generated from notes taken during the focus group. The final transcript was examined based on an analytic induction method for focus group research. Measurements and Main Results: Laparoscopic suturing and managing intraoperative laparoscopic complications were the highest priority skills across postgraduate years. The lowest priority skills were peg transfer and nonlaparoscopic suturing. Participants highlighted a need for a structured curriculum. They emphasized that skills learned during simulation would more likely be retained if they were simulated closer to when they would
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 be performed on a clinical rotation. Lastly, they believed that simulation was most valuable when combined with one-on-one instruction. Conclusion: Residents from different levels of training expressed similar needs for a MIGS curriculum. For a MIGS curriculum to succeed, simulation time needs to be built into existing clinical rotations. To improve knowledge retention, skills specific to a rotation should be simulated close to when they will be performed. There needs to be a mechanism for resident accountability and real time feedback.
578
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:09 PM – STATION H
Broadening the Scope of Surgical Simulation Dubin AK, Smith R. Nicholson Center, Florida Hospital, Celebration, Florida Study Objective: To identify new areas for surgical simulation to greatly improve clinician and support staff readiness for the OR. Design: Laparoscopic and robotic surgeries have led to the creation of multiple simulators to train skills needed by surgeons. All of these devices have followed the same path in addressing, almost exclusively, the psychomotor skills required by new surgeons. The devices have not leveraged the power of the computers, imagery, and other VR devices to represent and teach the entire process of preparing for and conducting a surgical procedure. We explore the broader applications of these technologies that are available now but which are not being exploited by the surgical simulation industry. Setting: Surgical education for surgeons, residents, medical students, surgical support staff. Patients: n/a. Intervention: We identified eight areas of surgery that the simulation world has the potential to address: surgical skills, surgical procedures, robot “buttonology”, planning process, imagery analysis and selection, room and patient placement, equipment and table layout, and complications and recovery.
579
S189
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:15 PM – STATION A
Can We Trust Simulator Performance Assessment? It Depends. Comparing Robotic Simulator Metrics Vs. GEARS on Simple Virtual Reality Exercises Dubin AK,1 Julian D,1 Tanaka ADS,1 Smith R,1 Mattingly PJ2. 1Nicholson Center, Florida Hospital, Celebration, Florida; 2Obstetrics and Gynecology, Columbia University, New York, New York Study Objective: Current surgical education relies heavily upon simulation and several assessment tools are available to the trainee including robotic simulator assessment metrics and the Global Evaluative Assessment of Robotic Skills (GEARS) metrics, both of which have been independently validated. GEARS is a rating scale through which human evaluators score trainees’ recorded performances. We used two common robotic simulators, the dV-Trainer (dVT) and the da Vinci Skills Simulator (dVSS), to compare the performance metrics of robotic surgical simulators to GEARS scores for a basic robotic task. Design: Prospective single-blinded randomized study. Setting: Surgical education and training center. Patients: Surgeons and surgeons in training. Intervention: Subjects performed two trials of Ring and Rail 1 (RR1) on each of two simulators (DV-SS and DVT) after undergoing randomization and warm-up exercises. The second RR1 trial simulator performance was recorded and the de-identified videos were sent to human reviewers who scored them using GEARS. Eight pairs of simulator assessment metrics and GEARS metrics were identified based on expert knowledge. Paired Metrics from Different Scoring Systems 1 2 3 4 5 6 7 8
GEARS Depth Perception Efficiency Efficiency Bimanual Dexterity Bimanual Dexterity Robotic Control Total Score Total Score
Simulator Metric Economy of Motion Master Workspace Range Time to Complete Economy of Motion Master Workspace Range Instrument Collisions Time to Complete Overall Score
A Spearman’s rho calculated for their level of correlation. Measurements and Main Results: 74 subjects were enrolled with 10 subjects excluded for incomplete data. There was a strong correlation between GEARS score and simulator metric score in Time to Complete vs Efficiency, Time to Complete vs Total Score, Economy of Motion vs Depth Perception, Total Score vs Overall Score (rho coefficients ≤-0.70). Those with weak correlation (rho ≥-0.30) were Bimanual Dexterity vs. Economy of Motion, Effeciency vs. Master Workspace Range, Bimanual Dexterity vs. Master Workspace Range, and Robotic control vs. Instrument Collisions. GEARS
Simulator Exercise
Rho*
p
Efficiency
DVSS- Time to Complete DVT- Time to Complete DVSS- Time to Complete DVT- Time to Complete DVSS- Economy of Motion DVT- Economy of Motion DVSS- Overall Score DVT-Overall Score DVSS-Economy of Motion DVT- Economy of Motion DVSS- Master Workspace Range DVT- Master Workspace Range DVSS-Master Workspace Range DVT- Master Workspace Range DVSS- Instrument Collisions DVT- Instrument Collisions
−0.81 −0.91 −0.83 −0.83 −0.78 −0.81 −0.69 −0.69 −0.31 −0.31 −0.24 −0.11 −0.21 −0.20 −0.28 −0.32
<.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 .0149 .0114 .0637 .3846 .1085 .1104 .0280 .0108
Total Score Measurements and Main Results: Generic surgical skills have been the main focus of surgical simulation and these devices are just beginning to include actual surgical procedures with representations of human tissue. They could also include robotic “buttonology” to teach a user how to operate the various controls of a robotic device; imagery analysis (MRI, US, CT) and surgical planning before a complicated procedure; proper patient preparation and placement in the OR; and appropriate responses to complications and emergencies. Conclusion: This analysis explored the capabilities of modern computers, tools, and VR systems to model important aspects of surgery beyond basic hand-eye skills which are predominant today. These already possess the power to represent and train a much larger set of situations that are important to a successful surgical procedure. It is time to expect more from the developers of these simulation systems.
Depth Perception Total Score Bimanual Dexterity Efficiency Bimanual Dexterity Robotic Control