Abstract
Introduction:
Simulation-based medical training is a well embedded educational technique for healthcare.
By providing hands-on and realistic opportunities, healthcare professionals can learn via ‘deliberate practice’ in a safe environment to develop practical and other skills and reflect on errors without risking patient harm.The RCOG report ‘Training in gynaecological surgery recovery plan’ recognised that changes must be implemented to continue to provide high quality gynaecological surgical training that existed pre pandemic.
We describe an innovate simulated laparoscopic training programme which shows that integrated simulation from an early stage of training provides rapid progression of skills, laparoscopic knowledge and skills.
Methodology:
• In 2021 we designed and implemented a laparoscopic simulation course for trainees
• of all stages across the Kent, Sussex and Surrey (KSS) training deanery.
• The course was held at a central hub and divided into three streams accommodating
• a maximum of 20 delegates per stream, based on their current training stage:
• Basic stream for ST1-2
• Intermediate stream for ST3-5
• Advanced stream for ST6 and ST7
Trainees received laparoscopic-box trainers (Inovus LapAR) and then four in-person sessions supplemented by lectures & practical exercises.
1 Each trainee completed a survey assessment (covering knowledge, skills and confidence) disseminated to 60 trainees (20 basic, intermediate and advanced), followed by a laparoscopic simulation course and repeat survey.
Results:
When rating their laparoscopic skills overall 45%, 52.8% and 80% positively in the basic, intermediate and advanced groups respectively. 25%/35% in the basic, 76.47%/70.59% in the intermediate and 100%/100% in the advanced group felt confident in performing safe entry/diagnostic laparoscopy.
10% in the basic group felt confident in performing salpingectomy compared to 58.82%/100% in the intermediate/advanced groups. 23.55% in the intermediate group felt confident in performing ovarian cystectomy compared to 60% in the advanced. 6.25%/23.53% and 20%/20% of intermediate and advanced trainees felt confident in performing hysterectomy/suturing. No trainees felt confident performing myomectomy.
Across all 60 trainees there was a statistically significant (p=<0.05) improvement in smoothness, time and speed. Within the beginner and intermediate groups there was a statistically significant (p=<0.05) improvement in laparoscopic knowledge, skills and confidence with beginner and intermediate operations (diagnostic laparoscopy, salpingectomy). Within the advanced group there was a statistically significant (p=<0.05) improvement in their confidence with advanced skills and operations (suturing, myomectomy, hysterectomy).
Conclusion:
Across all streams, an imbedded simulation programme significantly improves surgical performance. Despite high confidence for simple procedures, it is clear from the initial survey that confidence falls as complexity of the procedures increase. However, following the course, trainees in the basic stream showed the most significant improvement across all parameters measured, highlighting the benefits of embedding structured simulation programmes into the curriculum early in the training programme.