title: Integration and Validation of Hysteroscopy Simulation in the Surgical Training Curriculum.
abstract: OBJECTIVE
  The primary objective of our study was to test the construct validity of the HystSim hysteroscopic simulator to determine whether simulation training can improve the acquisition of hysteroscopic skills regardless of the previous levels of experience of the participants. The secondary objective was to analyze the performance of a selected task, using specially designed scoring charts to help reduce the learning curve for both novices and experienced surgeons.
  
  
  METHODS
  The teaching of hysteroscopic intervention has received only scant attention, focusing mainly on the development of physical models and box simulators. This encouraged our working group to search for a suitable hysteroscopic simulator module and to test its validation. We decided to use the HystSim hysteroscopic simulator, which is one of the few such simulators that has already completed a validation process, with high ratings for both realism and training capacity. As a testing tool for our study, we selected the myoma resection task. We analyzed the results using the multimetric score system suggested by HystSim, allowing a more precise interpretation of the results.
  
  
  METHODS
  Between June 2014 and May 2015, our group collected data on 57 participants of minimally invasive surgical training courses at the Kiel School of Gynecological Endoscopy, Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel.
  
  
  METHODS
  The novice group consisted of 42 medical students and residents with no prior experience in hysteroscopy, whereas the expert group consisted of 15 participants with more than 2 years of experience of advanced hysteroscopy operations.
  
  
  RESULTS
  The overall results demonstrated that all participants attained significant improvements between their pretest and posttests, independent of their previous levels of experience (p < 0.002). Those in the expert group demonstrated statistically significant, superior scores in the pretest and posttests (p = 0.001, p = 0.006). Regarding visualization and ergonomics, the novices showed a better pretest value than the experts; however, the experts were able to improve significantly during the posttest. These precise findings demonstrated that the multimetric scoring system achieved several important objectives, including clinical relevance, critical relevance, and training motivation.
  
  
  CONCLUSIONS
  All participants demonstrated improvements in their hysteroscopic skills, proving an adequate construct validation of the HystSim. Using the multimetric scoring system enabled a more accurate analysis of the performance of the participants independent of their levels of experience which could be an important key for streamlining the learning curve. Future studies testing the predictive validation of the simulator and frequency of the training intervals are necessary before the introduction of the simulator into the standard surgical training curriculum.
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany. Electronic address: dressawy@gmail.com.
authors: Mohamed
authors: M
authors: Elessawy
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Moritz
authors: M
authors: Skrzipczyk
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Christel
authors: C
authors: Eckmann-Scholz
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Nicolai
authors: N
authors: Maass
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Liselotte
authors: L
authors: Mettler
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Veronika
authors: V
authors: Guenther
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Marion
authors: M
authors: van Mackelenbergh
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Dirk O
authors: DO
authors: Bauerschlag
authors: Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
authors: Ibrahim
authors: I
authors: Alkatout
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods; D003198:Computer Simulation; D003479:Curriculum; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D005858:Germany; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D015907:Hysteroscopy / Q000193:education*; D008297:Male; D012189:Retrospective Studies; D000066908:Simulation Training
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; hysteroscopy; hysteroscopy simulation; residency training; surgical simulation