Proficiency in oocyte retrieval: how many procedures are necessary for training?

Abstract

Objective To determine a minimum number of procedures required for proficiency in oocyte retrieval and to characterize skill acquisition. Design Retrospective analysis. Setting Reproductive Endocrinology and Infertility fellowship training program. Study subjects Fellows in training from 2005-2007 and 2008-2010. Interventions None. Main outcome measures Proficiency scores (PS) were calculated by dividing the number of oocytes retrieved by oocytes expected (PS=oocytes retrieved/expected). 2005-2007 trainees were grouped and proficiency scores calculated as an average during specific points in their training. 2008-2010 trainees were compared individually to determine differences in individual skill acquisition. Results A greater number of oocytes were retrieved than expected, 8.6 vs. 7.6 (p <0.05). A relatively lower proficiency score (PS) was noted during the first 10 trainee aspirations (PS=1.1) compared to subsequent aspirations (PS=1.25 retrievals 11-20, PS=1.21 retrievals 21-30 and >31). When individual fellows’ scores were calculated, the majority achieved proficiency by 20 aspirations and all but one trainee achieved the mean staff PS by 50 retrievals. Conclusions Regardless of a trainee’s initial proficiency in oocyte retrieval, there are no statistically significant differences in the learning curve between trainees. The majority of individual fellows in training demonstrate proficiency in follicular aspirations within 20 procedures; however, a minority may require 50 procedures to achieve the proficiency of an attending physician. Capsule The majority of fellows in training demonstrate proficiency in follicular aspirations within 20 procedures; however, a minority may require 50 procedures to achieve the proficiency of an attending physician.

Proficiency in oocyte retrieval assessed by the learning curve cumulative summation test

“…However, these results contrast with the only study published about the learning curve of oocyte retrieval, which concluded that there was a short learning curve covering the first 10 retrievals, that oocyte retrieval was rapidly mastered by trainees and that there was no statistical difference in the learning curve between trainees (Goldman et al, 2011); however, the study was retrospective, whereas the LC-CUSUM enables a prospective monitoring of the learning process. The main outcome measure used by Goldman et al was a proficiency score calculated by dividing the number of oocytes retrieved by the oocytes expected defined by the number of follicles on the day of the human chorionic gonadotrophin trigger; in the current study, the number of oocytes collected was expressed as a ratio of the number of follicles ⩾14mm aspirated on the day of retrieval.…”

Transvaginal sonography in the diagnosis of deep infiltrating endometriosis: A review

“…Experience is prerequisite in the various US practices. [23][24][25] In a study by Tammaa et al, investigators examined the learning curve for the detection of pouch of Douglas obliteration and DIE of the rectum among trainees familiar with the general use of TVUS. 26 Tammaa et al found that trainees could become proficient in the diagnosis of endometriosis after approximately 40 examinations.…”

Fellowship training and board certification in reproductive endocrinology and infertility

“…One measure of the value of fellowship training in REI is the improvement in clinical outcomes that occur as a direct result of the research that is stimulated as part of the educational process leading to certification. Improvements in clinical outcomes for embryo transfer, sonohysterography, and oocyte retrieval have all been documented based on research performed in fellowship programs (6)(7)(8). It is likely that the establishment of a culture of improving clinical care based through research learned during training will carry over into clinical practice.…”