39: Validation of a low cost, low fidelity uterine model for diagnostic hysteroscopy training

Abstract

OBJECTIVES: Hysteroscopy is routinely used to diagnose and treat various gynecologic issues, necessitating a reliable method to train residents. Commercially available hysteroscopy models can be expensive for budget strapped programs e rendering them cost prohibitive in the training setting. A reusable, easily reproducible uterine model was created for simulation of camera navigation skills when identifying uterine landmarks. This study establishes construct and face validity of a new curriculum using a low cost hysteroscopy model. MATERIALS AND METHODS: The uterine model was constructed using an empty, clear 12-ounce Gatorade bottle. The cervix was fashioned from a hard Styrofoam ball with a continuous hole representing the cervical canal for hysteroscope placement. Six letters and symbols were placed on the bottle representing uterine landmarks. For task completion, the bottle was secured on a board using Velcro. An IRB exempt study at an urban academic center was conducted to evaluate the uterine model for construct and face validity. All first-year obstetrics and gynecology residents were included in the study. Participants were given a survey to obtain basic demographic information, previous hysteroscopy experience and comfort with performing the procedure. Participants then viewed an instructional video of the procedure utilizing the model. A hysteroscopy specific OSATS tool was developed by five experts to assess the steps of the procedure and included the categories: entry into cervix, identifying anatomical uterine landmarks, instrument handling, instrument safety, and knowledge of procedure. OSATS tool scores were compared between four experts (surgeons with 3 to 36 years of post-training experience) and the novice trainees. At study conclusion, participants completed a survey to assess model realism, comfort and preparedness for diagnostic hysteroscopy. RESULTS: All 18 first-year OB/GYN residents completed the study. Experts scored significantly higher than the residents overall on the OSATS tool (p < 0.001) and within each category with the exception of the identifying anatomical landmarks category (p ¼ 0.902). Of the 25 point maximum score, the mean overall OSATS tool score for the experts was 24.9 (SD AE .05), while the mean overall score for the residents was 13.8 (SD AE 1.83). Calculated median of repetitions for novice proficiency was 5.5 (SD AE 2.5). 77.8% of trainees and 100% of experts believed the model simulated the technical skills needed for diagnostic hysteroscopy skill realistically. 94.4% of trainees felt more comfortable and prepared performing a diagnostic hysteroscopy procedure as a result of training utilizing this uterine model. CONCLUSION: Construct and face validity was demonstrated for this curriculum. The data collected determined that the curriculum discriminates skill level. Both experts and novices were pleased with the ability of the uterine model to simulate diagnostic hysteroscopy. Further studies will be conducted for translation of skill to the clinical setting and impl...

Characteristics of hysteroscopic training models: A review of the literature

“…Non-biological material models refer to a type of training model that simulates the structure of human tissues using non-biological materials such as silicone and plastic. Published articles reported that diagnostic hysteroscopy, myomectomy, polypectomy, biopsy, and foreign body removal are the main procedures taught using non-biological material models in hysteroscopy simulation training [ [20] , [21] , [22] , [23] , [24] , [25] , 38 , 43 , [45] , [46] , [47] , [48] , [49] , [50] , [51] ].…”

“…In addition, some models are made from plastic bottles or are 3D-printed. Although they possess lower cost, they are low-fidelity and only suitable for teaching some basic skills [ 50 , 51 ].…”

“…15 studies investigated the applications of non-biological material models [ [20] , [21] , [22] , [23] , [24] , [25] , 38 , 43 , [45] , [46] , [47] , [48] , [49] , [50] , [51] ]. The curriculum of hysteroscopy simulation training included single hands-on simulator practice [ 38 ]; theory teaching and hands-on training with pre-test and post-test [ 21 , 43 , 45 ] or only with post-test post-test [ 20 , 24 , 46 , 49 , 51 ]; repetitive hands-on training with or without a time interval/educational instructions [ 20 , 22 , 23 , 25 , 48 ].…”

“…15 studies investigated the applications of non-biological material models [ [20] , [21] , [22] , [23] , [24] , [25] , 38 , 43 , [45] , [46] , [47] , [48] , [49] , [50] , [51] ]. The curriculum of hysteroscopy simulation training included single hands-on simulator practice [ 38 ]; theory teaching and hands-on training with pre-test and post-test [ 21 , 43 , 45 ] or only with post-test post-test [ 20 , 24 , 46 , 49 , 51 ]; repetitive hands-on training with or without a time interval/educational instructions [ 20 , 22 , 23 , 25 , 48 ]. 3 studies assessed technical skills [ 20 , 21 , 24 , 25 , 38 , 45 , [48] , [49] , [50] ]; 6 studies examined sterilization procedures [ 43 ]; 3 studies assessed diagnostic hysteroscopic skills [ 22 , 23 , 25 , 46 , 49 ]; and 2 studies assessed theoretical knowledge [ 21 , 43 ].…”