title: Survey on Barriers to Adoption of Laparoscopic Surgery.
abstract: OBJECTIVE
  To identify challenges that impede wider adoption of laparoscopy in gynecologic surgery and assessing whether the current training programs are addressing these challenges adequately.
  
  
  METHODS
  A survey was designed to examine barriers to adoption of laparoscopy for practicing gynecologists. The survey was piloted on gynecologic surgeons and was further refined following their feedback. Finally, the survey was deployed to 4273 gynecologists across the United States via e-mail using the national database of the American Medical Association. Respondents were grouped into two categories based on how often they report referral of patients for laparoscopy. Demographics, training, and practice characteristics were compared using Fisher exact tests for categorical variables and t tests for continuous variables. Participants rated factors that were thought to limit laparoscopy use on a 5-point Likert scale; median values of these scores were compared with Wilcoxon rank sum tests.
  
  
  RESULTS
  We received 210 responses (29% of people who opened the e-mail and 93% of those who opened the survey). Physicians who perform their own laparoscopies were on average younger and tended to be more subspecialized. Some of the most highly rated limiting factors included lack of adequate surgical volume, reluctance of managing unexpected surgical scenarios, difficulty with video-eye-hand coordination, altered depth perception, and laparoscopic suturing.
  
  
  CONCLUSIONS
  This survey identified barriers to adoption of laparoscopic surgical techniques beyond what has previously been identified. Based on these findings, novel simulation and continuing medical education curricula can be created to address the primary barriers in order to increase laparoscopic approach to surgery among gynecologists.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Noga
authors.initials: N
authors.lastname: Fuchs Weizman
authors.affiliation: Harvard Catalyst, Harvard University, Boston, Massachusetts.
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.affiliation: Harvard Catalyst, Harvard University, Boston, Massachusetts.
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
authors.affiliation: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: scohen20@partners.org.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
mesh_terms: D004502:Education, Medical, Continuing; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; barriers to adoption of laparoscopy; continued medical education for laparoscopic surgeons; laparoscopy; surgical education; survey