title: Traditional Versus Simulation Resident Surgical Laparoscopic Salpingectomy Training: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of the porcine training model for obstetrics-gynecology (OB/GYN) residents in laparoscopic salpingectomy.
  
  
  METHODS
  Randomized, controlled single-blinded trial.
  
  
  METHODS
  Canadian Task Force Classification I.
  
  
  METHODS
  A large community-based teaching hospital.
  
  
  METHODS
  All postgraduate year 1 through year 4 OB/GYN residents were enrolled (n = 22).
  
  
  METHODS
  All participants underwent a preintervention objective skills assessment test (OSAT), in which the participant performed live human laparoscopic salpingectomy. Residents were randomly assigned (using a computer-generated randomization table, in blocks of 2, stratified by ranked baseline OSAT scores) to the intervention or control group. The intervention group consisted of 1 educational session with presession assigned reading, a 40-min didactic lecture, viewing of a procedural video, and simulation and practice of laparoscopic salpingectomy on a porcine cadaver. The control group received traditional training per routine residency rotations.
  
  
  RESULTS
  Laparoscopic salpingectomy was performed on live patients by study participants pre- and postintervention. These procedures were video recorded, and then scored by a single blinded evaluator of the OSATs. Nine pre- and postintervention OSAT indicators, reflecting provider knowledge and skill, were the primary outcome measures. Secondary outcomes were the changes in 10 subjective measures of comfort, assessed by a pre- and postintervention survey. The outcomes were assessed using 5-point Likert scales (for OSATs 1 = lowest score; for the subjective survey 1 = highest score). The control group OSAT scores did not change (pre: 26.6 ± 10.8, post: 26.2 ± 10.1; p = .65). There were significant improvements in 2-handed surgery (pre: 2.8 ± 1.6, post: 3.5 ± 1.3; p = .004) and use of energy (pre: 2.9 ± 1.3, post: 3.6 ± 1.0; p = .01) in the intervention group, contributing to an overall score change (pre: 26.7 ± 10.6, post: 29.9 ± 9.8; p ≤ .001). The control group had no change in comfort levels. The intervention group experienced both increases (anatomy, steps of surgery, 2-handed surgery, and use of energy) and decreases (reading and learning in operating room) in reported comfort levels.
  
  
  CONCLUSIONS
  This study demonstrates that simulation can improve surgical technique OSATs. However, of 45 possible points, both groups' average scores were <70% of the optimum. Thus, the improvement, although statistically significant, was relatively small and indicates that further supplementation in training is needed to substantially increase the residents' surgical skills.
authors.affiliation: Department of Minimally Invasive Gynecologic Surgery, Christiana Care Health Systems, Newark, Delaware. Electronic address: npatel@christianacare.org.
authors.forename: Nima R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: Department of Minimally Invasive Gynecologic Surgery, Christiana Care Health Systems, Newark, Delaware.
authors.forename: Gretchen E
authors.initials: GE
authors.lastname: Makai
authors.affiliation: Department of Obstetrics and Gynecology, Women's and Children's Health Research, Christiana Care Health Systems, Newark, Delaware.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sloan
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Della Badia
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence / Q000706:statistics & numerical data; D004195:Disease Models, Animal; D005260:Female; D006176:Gynecology / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education / Q000592:standards; D009774:Obstetrics / Q000193:education* / Q000592:standards; D010820:Physicians; D058994:Salpingectomy / Q000193:education / Q000592:standards; D013536:Suture Techniques; D013552:Swine
keywords: Laparoscopic; Resident; Salpingectomy; Simulation; Training