TY - JOUR
T1 - Correlation of surgical case volume and fellowship training with performance on simulated procedural tasks
AU - Doneza, Janine A.
AU - Palvia, Vijay
AU - Lerner, Veronica T.
AU - Overbey, Jessica
AU - Levie, Mark
AU - Brodman, Michael
AU - Ascher-Walsh, Charles
N1 - Funding Information:
We thank Ms. Peiying Hua and Ms. Stephanie Pan from the Center for Biostatistics, Icahn School of Medicine at Mount Sinai, for their assistance in data analysis; we also thank Ms Sofia Windmiller and Mr Elliot Levie for their technical assistance on the simulator.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Background: High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges. Objective: To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks. Study Design: A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics. Results: Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=−0.32, P=.0007 and r=−0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=−0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7–595.2]) vs 530.2 seconds (interquartile range, 406.2–605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8–7.3) vs 8.1 m (interquartile range, 5.8–10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8–37.7) vs 42.9 mL (interquartile range, 18.1–70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure. Conclusion: Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes.
AB - Background: High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges. Objective: To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks. Study Design: A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics. Results: Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=−0.32, P=.0007 and r=−0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=−0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7–595.2]) vs 530.2 seconds (interquartile range, 406.2–605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8–7.3) vs 8.1 m (interquartile range, 5.8–10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8–37.7) vs 42.9 mL (interquartile range, 18.1–70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure. Conclusion: Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes.
KW - clinical competence
KW - credentialing
KW - fellowship
KW - gynecology
KW - laparoscopic surgery
KW - laparoscopy standards
KW - maintenance of certification
KW - physician standards
KW - simulation training
KW - surgery
KW - surgical volume
KW - validity
UR - http://www.scopus.com/inward/record.url?scp=85111990300&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2021.06.062
DO - 10.1016/j.ajog.2021.06.062
M3 - Article
C2 - 34147495
AN - SCOPUS:85111990300
SN - 0002-9378
VL - 225
SP - 548.e1-548.e10
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 5
ER -