title: Effect of validated skills simulation on operating room performance in obstetrics and gynecology residents: a randomized controlled trial.
abstract: OBJECTIVE
  To estimate whether training on previously validated laparoscopic skill stations translates into improved technical performance in the operating room.
  
  
  METHODS
  We performed a multicenter, randomized, controlled trial evaluating the performance of a laparoscopic bilateral midsegment salpingectomy. Residents were randomized to either traditional teaching (no simulation) or faculty-directed sessions in a simulation laboratory. A sample size of at least 44 lower-level residents (postgraduate year [PGY] 1 or 2) and 66 upper-level (PGY 3 or 4) were necessary to demonstrate a 50% improvement in performance assuming an α error of 0.05 and β error of 0.20 for each group independently. The primary outcomes were the final total normalized simulation score and the operating room performance score. Paired t test and Wilcoxon rank-sum tests were used to evaluate the differences within and between cohorts. Our final model involved a multiple linear regression analysis for the main effects of a priori--specified variables.
  
  
  RESULTS
  We enrolled 116 residents from eight centers across the United States. There was no statistically significant difference in baseline simulation or operative performances. Although both groups demonstrated improvement with time, the trained group improved significantly higher normalized simulation scores (378 ± 54 compared with 264 ± 86; P<.01) and higher levels of competence on the simulated tasks (96.2% compared with 61.1%; P<.01). The simulation group also had higher objective structured assessment of technical skills scores in the operating room (27.5 compared with 30.0; P=.03).
  
  
  CONCLUSIONS
  We found that proficiency-based simulation offers additional benefit to traditional education for all levels of residents. The use of easily accessible, low-fidelity tasks should be incorporated into formal laparoscopic training.
authors: Departments of Obstetrics and Gynecology, Ochsner Clinical School, New Orleans, Louisiana, University of Texas, Houston, Houston, Texas, Orlando Health, Orlando, Florida, Virginia Commonwealth University, Richmond, Virginia, and University of Texas Southwestern Medical Center, Dallas, Texas; the Center for Clinical Research and Evidence-Based Medicine, University of Texas, Houston, Houston, Texas; and Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors: Rajiv
authors: R
authors: Gala
authors: Francisco
authors: F
authors: Orejuela
authors: Kim
authors: K
authors: Gerten
authors: Ernest
authors: E
authors: Lockrow
authors: Charles
authors: C
authors: Kilpatrick
authors: Lubna
authors: L
authors: Chohan
authors: Charles
authors: C
authors: Green
authors: Jessica
authors: J
authors: Vaught
authors: Aaron
authors: A
authors: Goldberg
authors: Joseph
authors: J
authors: Schaffer
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D010535:Laparoscopy / Q000193:education*; D008297:Male; D009774:Obstetrics / Q000193:education* / Q000592:standards; D058994:Salpingectomy / Q000193:education*; D013536:Suture Techniques / Q000193:education
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