Development and Validation of Diagnostic Hysteroscopy Simulation Curriculum [9L]

Abstract

INTRODUCTION: Hysteroscopy is a cornerstone operative skill for gynecologists. As with other technical skills, simulation training may improve performance in the OR. Cavitary foods (e.g. bell pepper) have been used as models but these have the limitation of being inflexible and short lived. We have developed a low-fidelity, reusable and reproducible training model using a clear plastic bottle for hysteroscopic simulation. This purpose of this study is to test the face and construct validity of that model. METHODS: This is a prospective observational study. In 2017 and 2018 first year residents in Obstetrics and Gynecology at UT Southwestern completed the curriculum, including instructional videos, pre-test and post-test surveys and a the simulation task. Expert faculty administered an objective structured assembly of technical skills (OSATS) and recorded times required to assemble the hysteroscope and perform the simulation. Residents were given 6 weeks for independent practice with the model after which the OSATS and performance times were collected again. RESULTS: 36 first year residents and 4 faculty experts completed the simulation. Following independent practice, resident OSAT scores improved by 11 points (SD ± 8, out of 39 potential total points) on assembly of hysteroscope and 9 points (SD ± 3.5, out of 15 potential points) on simulation tasks. Resident OSATS scores improved significantly (p<0.005) between pre-test and post-test. Experts scored significantly higher than the residents on the OSATS overall (p < .001). CONCLUSION: Our study supports the use of our reusable hysteroscopic training model as a way to improve resident performance in a simulation environment.

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 ].…”

“…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 ]. Overall, these studies demonstrated that both technical skills and theoretical knowledge were enhanced with simulation training.…”