title: Does residency training improve cognitive competence in obstetric and gynaecologic surgery?
abstract: OBJECTIVE
  To develop an operative knowledge assessment tool to evaluate the cognitive competence of trainees in obstetric and gynaecologic surgery and to determine the rate of change in competence during a five-year residency program.
  
  
  METHODS
  Twenty-eight participants in five training groups (PGY-1 to PGY-5) in McGill University's residency program in obstetrics and gynaecology underwent an evaluation based on surgical cognitive competence (SCC) assessment tools developed for three different obstetric and gynaecologic operations: open total abdominal hysterectomy (TAH), Caesarean section, and laparoscopic bilateral tubal sterilization (BTL). The tools were developed as checklists listing every step in each operation based on techniques described in current surgical texts. Using analysis of variance and linear regressions, statistical significance was established for procedure-specific scores and overall SCC scores. In addition, the rate of change of cognitive competence throughout the training years was calculated. Finally, using a t test, the overall SCC score was compared to a "critical steps score".
  
  
  RESULTS
  Critical steps scores and overall SCC scores increased with training experience at an average yearly rate of 13.36% (P < 0.001). Procedure-specific scores increased yearly, by 15.73% for TAH (P < 0.001), 8.06% for Caesarean section (P < 0.001), and 16.31% for BTL (P < 0.001). The difference between overall scores and critical steps scores was not statistically significant for the study cohort (P = 0.94).
  
  
  CONCLUSIONS
  Surgical cognitive competence among obstetrics and gynaecology residents can be reliably assessed with our evaluation tool, and it increases proportionally with residency education, reaching maximum scores during the final year of training. This type of information may be helpful in ascertaining how long a residency program should be.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal QC.
authors.forename: Jacques
authors.initials: J
authors.lastname: Balayla
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal QC.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal QC; Department of Oncology, McGill University, Montreal QC; Center for Medical Education, McGill University, Montreal QC.
authors.forename: Markus C
authors.initials: MC
authors.lastname: Martin
mesh_terms: D002585:Cesarean Section / Q000193:education; D002983:Clinical Competence; D003071:Cognition; D003479:Curriculum; D004521:Educational Measurement; D013509:Gynecologic Surgical Procedures / Q000193:education*; D007044:Hysterectomy / Q000193:education; D007396:Internship and Residency; D013513:Obstetric Surgical Procedures / Q000193:education*; D013246:Sterilization, Tubal / Q000193:education