title: Validating a standardized laparoscopy curriculum for gynecology residents: a randomized controlled trial.
abstract: BACKGROUND
  Residency programs struggle with integrating simulation training into curricula, despite evidence that simulation leads to improved operating room performance and patient outcomes. Currently, there is no standardized laparoscopic training program available for gynecology residents.
  
  
  OBJECTIVE
  The purpose of this study was to develop and validate a comprehensive ex vivo training curriculum for gynecologic laparoscopy.
  
  
  METHODS
  In a prospective, single-blinded randomized controlled trial (Canadian Task Force Classification I) postgraduate year 1 and 2 gynecology residents were allocated randomly to receive either conventional residency training or an evidence-based laparoscopy curriculum. The 7-week curriculum consisted of cognitive didactic and interactive sessions, low-fidelity box trainer and high-fidelity virtual reality simulator technical skills, and high-fidelity team simulation. The primary outcome measure was the technical procedure score at laparoscopic salpingectomy with the use of the objective structured assessment of laparoscopic salpingectomy tool. Secondary outcome measures related to performance in multiple-choice questions and technical performance at box trainer and virtual reality simulator tasks. A sample size of 10 residents per group was planned (n = 20). Results are reported as medians (interquartile ranges), and data were compared between groups with the Mann-Whitney U, chi-square, and Fisher's exact tests (P ≤ .05).
  
  
  RESULTS
  In July 2013, 27 residents were assigned randomly (14 curriculum, 13 conventional). Both groups were similar at baseline. Twenty-one residents (10 curriculum, 11 conventional) completed the surgical procedure-based assessment in the operating room (September to December 2013). Our primary outcome indicated that curriculum-trained residents displayed superior performance at laparoscopic salpingectomy (P = .043). Secondary outcomes demonstrated that curriculum-trained residents had higher performance scores on the cognitive multiple-choice questions (P < .001), the nontechnical skills multiple-choice questions (P = .016), box trainer task time (P < .001), and all virtual reality simulator parameters.
  
  
  CONCLUSIONS
  Participation in a comprehensive simulation-based training curriculum for gynecologic laparoscopy leads to a superior improvement in knowledge and technical performance in the operating room compared with conventional residency training.
authors.affiliation: Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada. Electronic address: shore@smh.ca.
authors.forename: Eliane M
authors.initials: EM
authors.lastname: Shore
authors.affiliation: Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
authors.affiliation: Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Husslein
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Shirreff
authors.affiliation: Department of Surgery, Gold Coast University Hospital, Southport, Australia.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Dedy
authors.affiliation: Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Colleen D
authors.initials: CD
authors.lastname: McDermott
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Guylaine G
authors.initials: GG
authors.lastname: Lefebvre
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum / Q000592:standards*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D016037:Single-Blind Method
keywords: competency-based education; curriculum; gynecology; laparoscopy; resident; simulation; surgery