Procedure-Specific Resident Objective Modular Training Evaluation

1. Purpose:

The purpose is to investigate whether procedure-specific skills acquired in a surgical lab result in improved OR surgical skills; to examine related outcomes of intra-operative events and resident satisfaction; to examine the feasibility of implementation of modular training in a gynecology residency program. 2. Hypothesis: That the surgical training modules proposed will improve resident surgical skills in the operating room. 3. Justification:

Increasing constraints are placed on the educational experience of young surgical trainees. Specifically in the area of Obstetrics and Gynecology (ObGyn), residents are expected to become skilled surgeons in addition to acquiring vast knowledge on a myriad of women's health topics. Operating room (OR) time is scarce. Medicolegal concerns can be a limitation to resident involvement. Financial incentives to support surgical mentorship are dwindling. With the rapid acceptance and advancement of minimally invasive surgical techniques in gynecology, there is a learning curve for the attending surgeons who must familiarize themselves with the techniques first and thus give fewer practice opportunities to residents.

Traditionally, acquisition of surgical technical skills happens through repetition in the OR, under the supervision of an experienced surgeon. Because of the above named constraints, surgical education of residents has been referred to as "education by random opportunity". Surgical educators have thus attempted to teach in other settings, remote from the OR. Options have included the use of suturing stations, animal and cadaver models, videotapes of procedures and laparoscopic simulators. Although the efficacy of these options is recognized, few ObGyn programs provide formal surgical curricula and technical skills are still taught mostly in the OR and through lectures. A survey of all the 266 ObGyn residency programs in the United States, published more than 10 years ago, showed that surgical teaching curricula were only used by 29% of the programs. A more recent survey conducted in Canada showed that, 10 years later, only 40% of Canadian ObGyn programs compared to 76% of other surgical residencies used a program-specific surgical training curriculum. Most Canadian residency program directors who did not have access to a standard training curriculum wished to have one implemented. Results of this survey are consistent with other Canadian studies showing variability in training and assessment of surgical skill across Canada. Without a formal curriculum, residents may graduate with widely varying surgical skills, currently not objectively evaluated as a requirement for graduation.

There are obvious advantages to a surgical training curriculum remote from the OR. Residents can practice basic and advanced skills as many times as necessary to achieve competency prior to performing surgeries on real patients. Patient safety is thus not compromised. Dedicated teaching faculty can provide immediate feedback. If training objectives are not met, mandatory retraining targeted to specific deficient areas can be undertaken on the same modules.