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Cystoscopy Curriculum: A Needs Assessment of Obstetrics and Gynecology Residency Programs
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S45–S90 289
Open Communications 15 - Education (2:57 PM - 3:02 PM)
Bringing Laparoscopy to Haiti, a Pilot Program Maxis CP,1 Tang NZ,2 Lian X,1 D’Haiti S,1 Millien C.3 1Obstetrics & Gynecology, Stony Brook Medicine, Stony Brook, New York; 2Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, New York; 3 Obstetrics & Gynecology, University Hospital at Mirebalais, Mirebalais, Haiti Study Objective: To introduce gynecologic laparoscopy to Haitian gynecologists. Design: OBGYN physicians in Haiti with limited experience with laparoscopy were enrolled in a combined didactic and simulation-based laparoscopy workshop. Setting: The workshop was conducted at a tertiary care hospital in Mirebalais, Haiti where a high volume of gynecologic procedures are performed annually. Patients: Eleven attending gynecologists were enrolled in the workshop. Intervention: The participants were administered a pre-intervention assessment, written based on the ‘‘Fundamental of Laparoscopic Surgery’’ modules through SAGES, of their knowledge of basic laparoscopic principles. They then attended lectures on laparoscopic principles and techniques and practiced these techniques using laparoscopic box trainers with tasks ranging from simple peg transfers, to simulations for tubal ligation and ovarian cystectomy. Finally the participants were administered a ‘‘posttest’’ to assess their retention of the material. Measurements and Main Results: The average pretest score was 44.6% and the average posttest score was 75.9%, with each individual having an average improvement in score of 31.3% on the posttest. 100% of participants stated that their knowledge of laparoscopy prior to the workshop was ‘‘poor’’ but were ‘‘very interested’’ in furthering their knowledge. 82% reported observing at least one laparoscopic procedure prior to this workshop, but only 18% reported assisting in any of those procedures. After the workshop, 100% of the participants stated that they would be ‘‘more likely’’ to try laparoscopic techniques on their own and that the ability to perform diagnostic laparoscopies and tubal ligations would be the most beneficial to their practice. Conclusion: Haitian gynecologists, although limited in technology and resources, have some exposure to laparoscopy and recognize its utility for their patient population. Our project demonstrates an easy and inexpensive intervention to improve physician skills and knowledge in laparoscopy. However, more long-term studies are needed to assess the application of these techniques and as well as patient outcomes. 290
Open Communications 15 - Education (3:03 PM - 3:08 PM)
A Validation Study: Does Use of an Interactive Computer Based Laparoscopic Hysterectomy Trainer Expand Cognitive Surgical Knowledge of Ob/Gyn Trainees beyond That of Traditional Educational Tools? Lichtman AS,1 Goff B,2 Schreuder HWR,3 Lenihan J Jr,2 Lefebvre G,4 Parker W,5 Mehra N,6 Ciotti M,1 Chiang A.5 1Obsetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California; 2Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; 3 Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands; 4Obs-Gyn, University of Toronto, Toronto, Ontario, Canada; 5 Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; 6Obstetrics and Gynaecology, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada Study Objective: To assesses improvement in cognitive knowledge of Ob/ Gyn trainees following interactive computer-based instruction in pelvic anatomy, performance of laparoscopic hysterectomy and avoidance of surgical complications compared to traditional training.
S87
Design: Internet-based pre and post-tests assessed requisite knowledge in both phases. Phase 1: 20 expert laparoscopic surgeons, 20 upper level residents and 20 novices from 6 separate institutions were tested to establish baseline knowledge. Phase 2: All PGY 1 and 2 residents were administered the pre-test and then randomized to computer program training or current surgical training. After the first gynecology rotation, both groups were re-tested. Setting: University of Southern California; University of Washington; Utrecht, The Netherlands; University of Toronto; University of California, Los Angeles; University of British Columbia. Intervention: Computer-based surgical training or current resident surgical training. Measurements and Main Results: Phase I determined the validity of the tests and created a ‘‘knowledge curve.’’ Reliability and validity of the tests were analyzed. To assess construct validity, resident and faculty performances were analyzed using a one-way analysis of variance with level of training as the independent variable. Student-Newman-Keuls test was used for post-hoc contrasts. Cronbach’s alpha test was calculated for internal consistency (reliability) of the tests. Phase 2 used a paired t-test to assess degree of improvement in surgical knowledge, with each trainee serving as his/her own control. Resident scores were compared with novice surgeons, more advanced residents, established practitioners and recognized experts. Study results will be presented. Conclusion: Trainees who used the computer surgical trainer had higher post-test scores than residents with standard surgical training.
291
Open Communications 15 - Education (3:09 PM - 3:14 PM)
Cystoscopy Curriculum: A Needs Assessment of Obstetrics and Gynecology Residency Programs Scott LA, Mikail E, Greene KA, Wymann A, Hart S. Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of South Florida, Tampa, Florida Study Objective: To determine if there is a perceived need for a standardized cystoscopy curriculum for obstetrics and gynecology residency programs. Design: Electronic Survey. Patients: 260 Residency Program Directors in the United States, Puerto Rico, and Canada. Intervention: Emails were sent to 260 Residency Program Directors in the United States, Puerto Rico and Canada obtained from the CREOG Directory. Of those, 1 person responded that they no longer had residents and eight were undeliverable. An original email inviting the Residency Program Directors to participate was sent and two reminder emails were mailed after 3 and 6 weeks. Measurements and Main Results: Fifty-seven Residency Program Directors responded and completed the survey. The majority of respondents were Generalists (66%)and from University affiliated programs (64%). A formal cystoscopy curriculum (defined as a planned program of objectives, learning experiences, resources, and assessment) was present in 10% of the respondents. Forty-Three percent of programs had no cystoscopy curriculum. The majority of the programs with a cystoscopy curriculum had a FPMRS fellowship (70%). Cystoscopy curriculums incorporated role-modeling in the operating room as one of their main sources of teaching (93%) and only 38 % incorporated simulation. While the majority residents left residency with credentialing for cystoscopy (84%), only 6 % are evaluated using an Objective Structured Assessment of Technical Skills. Of those that did not have a formal cystoscopy curriculum, 57 % would like to institute one and 43% were either neutral or did not want to implement a curriculum. Conclusion: The majority of program directors believe that cystoscopy training is important for Obstetrician and Gynecology residents, but very few have a formal cystoscopy curriculum with objectives, resources, learning experiences, resources and assessment.
Open Communications 15 - Education (2:57 PM - 3:02 PM)
Bringing Laparoscopy to Haiti, a Pilot Program Maxis CP,1 Tang NZ,2 Lian X,1 D’Haiti S,1 Millien C.3 1Obstetrics & Gynecology, Stony Brook Medicine, Stony Brook, New York; 2Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, New York; 3 Obstetrics & Gynecology, University Hospital at Mirebalais, Mirebalais, Haiti Study Objective: To introduce gynecologic laparoscopy to Haitian gynecologists. Design: OBGYN physicians in Haiti with limited experience with laparoscopy were enrolled in a combined didactic and simulation-based laparoscopy workshop. Setting: The workshop was conducted at a tertiary care hospital in Mirebalais, Haiti where a high volume of gynecologic procedures are performed annually. Patients: Eleven attending gynecologists were enrolled in the workshop. Intervention: The participants were administered a pre-intervention assessment, written based on the ‘‘Fundamental of Laparoscopic Surgery’’ modules through SAGES, of their knowledge of basic laparoscopic principles. They then attended lectures on laparoscopic principles and techniques and practiced these techniques using laparoscopic box trainers with tasks ranging from simple peg transfers, to simulations for tubal ligation and ovarian cystectomy. Finally the participants were administered a ‘‘posttest’’ to assess their retention of the material. Measurements and Main Results: The average pretest score was 44.6% and the average posttest score was 75.9%, with each individual having an average improvement in score of 31.3% on the posttest. 100% of participants stated that their knowledge of laparoscopy prior to the workshop was ‘‘poor’’ but were ‘‘very interested’’ in furthering their knowledge. 82% reported observing at least one laparoscopic procedure prior to this workshop, but only 18% reported assisting in any of those procedures. After the workshop, 100% of the participants stated that they would be ‘‘more likely’’ to try laparoscopic techniques on their own and that the ability to perform diagnostic laparoscopies and tubal ligations would be the most beneficial to their practice. Conclusion: Haitian gynecologists, although limited in technology and resources, have some exposure to laparoscopy and recognize its utility for their patient population. Our project demonstrates an easy and inexpensive intervention to improve physician skills and knowledge in laparoscopy. However, more long-term studies are needed to assess the application of these techniques and as well as patient outcomes. 290
Open Communications 15 - Education (3:03 PM - 3:08 PM)
A Validation Study: Does Use of an Interactive Computer Based Laparoscopic Hysterectomy Trainer Expand Cognitive Surgical Knowledge of Ob/Gyn Trainees beyond That of Traditional Educational Tools? Lichtman AS,1 Goff B,2 Schreuder HWR,3 Lenihan J Jr,2 Lefebvre G,4 Parker W,5 Mehra N,6 Ciotti M,1 Chiang A.5 1Obsetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California; 2Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; 3 Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands; 4Obs-Gyn, University of Toronto, Toronto, Ontario, Canada; 5 Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; 6Obstetrics and Gynaecology, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada Study Objective: To assesses improvement in cognitive knowledge of Ob/ Gyn trainees following interactive computer-based instruction in pelvic anatomy, performance of laparoscopic hysterectomy and avoidance of surgical complications compared to traditional training.
S87
Design: Internet-based pre and post-tests assessed requisite knowledge in both phases. Phase 1: 20 expert laparoscopic surgeons, 20 upper level residents and 20 novices from 6 separate institutions were tested to establish baseline knowledge. Phase 2: All PGY 1 and 2 residents were administered the pre-test and then randomized to computer program training or current surgical training. After the first gynecology rotation, both groups were re-tested. Setting: University of Southern California; University of Washington; Utrecht, The Netherlands; University of Toronto; University of California, Los Angeles; University of British Columbia. Intervention: Computer-based surgical training or current resident surgical training. Measurements and Main Results: Phase I determined the validity of the tests and created a ‘‘knowledge curve.’’ Reliability and validity of the tests were analyzed. To assess construct validity, resident and faculty performances were analyzed using a one-way analysis of variance with level of training as the independent variable. Student-Newman-Keuls test was used for post-hoc contrasts. Cronbach’s alpha test was calculated for internal consistency (reliability) of the tests. Phase 2 used a paired t-test to assess degree of improvement in surgical knowledge, with each trainee serving as his/her own control. Resident scores were compared with novice surgeons, more advanced residents, established practitioners and recognized experts. Study results will be presented. Conclusion: Trainees who used the computer surgical trainer had higher post-test scores than residents with standard surgical training.
291
Open Communications 15 - Education (3:09 PM - 3:14 PM)
Cystoscopy Curriculum: A Needs Assessment of Obstetrics and Gynecology Residency Programs Scott LA, Mikail E, Greene KA, Wymann A, Hart S. Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of South Florida, Tampa, Florida Study Objective: To determine if there is a perceived need for a standardized cystoscopy curriculum for obstetrics and gynecology residency programs. Design: Electronic Survey. Patients: 260 Residency Program Directors in the United States, Puerto Rico, and Canada. Intervention: Emails were sent to 260 Residency Program Directors in the United States, Puerto Rico and Canada obtained from the CREOG Directory. Of those, 1 person responded that they no longer had residents and eight were undeliverable. An original email inviting the Residency Program Directors to participate was sent and two reminder emails were mailed after 3 and 6 weeks. Measurements and Main Results: Fifty-seven Residency Program Directors responded and completed the survey. The majority of respondents were Generalists (66%)and from University affiliated programs (64%). A formal cystoscopy curriculum (defined as a planned program of objectives, learning experiences, resources, and assessment) was present in 10% of the respondents. Forty-Three percent of programs had no cystoscopy curriculum. The majority of the programs with a cystoscopy curriculum had a FPMRS fellowship (70%). Cystoscopy curriculums incorporated role-modeling in the operating room as one of their main sources of teaching (93%) and only 38 % incorporated simulation. While the majority residents left residency with credentialing for cystoscopy (84%), only 6 % are evaluated using an Objective Structured Assessment of Technical Skills. Of those that did not have a formal cystoscopy curriculum, 57 % would like to institute one and 43% were either neutral or did not want to implement a curriculum. Conclusion: The majority of program directors believe that cystoscopy training is important for Obstetrician and Gynecology residents, but very few have a formal cystoscopy curriculum with objectives, resources, learning experiences, resources and assessment.