Proficiency for Advanced Laparoscopic Procedures in Gynecologic Residency Program: Do all Residents Need to be Trained?
OBJECTIVE
To assess the current state of laparoscopic gynecologic surgery in the Dutch residency program, the level of competence among graduated residents, and whether they still perform these procedures. Furthermore, their current attitudes toward the implementation of minimally invasive surgery into residency training were assessed.


METHODS
An online survey (Canadian Task Force Classification III) regarding the level of competence, performance, training, and interest for gynecologic laparoscopic procedures.


METHODS
Gynecologists who finished residency training between 2008 and 2013 in the Netherlands.


RESULTS
Response rate was 73% (171/235). The scores for all basic and intermediate laparoscopic procedures performed immediately after residency showed the highest competence level (median 5, of scale 1-5). The competence level for advanced laparoscopic procedures was less at 3, indicating that the graduated residents are not able to perform these procedures without supervision. Overall, 56% of the gynecologists no longer perform any level 3 advanced procedures, and 86% do not perform level 4 advanced procedures. Gynecologists who still perform the inquired laparoscopic procedures scored a significantly higher competence level immediately after residency training for most of procedures compared with the gynecologists who do not perform these procedures.


CONCLUSIONS
Residents are sufficiently trained for basic and intermediate laparoscopic procedures during residency training. However, they are not sufficiently equipped to perform advanced laparoscopic procedures without supervision. We should consider training advanced procedures especially to a selected group of residents because most gynecologists do not perform these procedures after residency. The learning curve for advanced procedures continues to rise after finishing residency for those who keep on performing these procedures, therefore an additional fellowship is recommended for this group.
Minimally Invasive Surgery, Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
Sara R C
SR
Driessen
Department of Gynecology and Obstetrics, St. Antonius Hospital, Nieuwegein, the Netherlands.
Juliënne A
JA
Janse
Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
Henk W R
HW
Schreuder
Minimally Invasive Surgery, Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; Department BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands. Electronic address: f.w.jansen@lumc.nl.
Frank Willem
FW
Jansen
D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D009426:Netherlands
Gynecology; Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; education; laparoscopy; residency; training