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Practice Makes Progress

A national study on simulation training is changing how obstetrics and gynecology practitioners learn to perform surgeries.

Research  |  Oct 3, 2018  |  By Nicole Rupersburg
Dr. Nadia Gomez

Dr. Nadia Gomez is UNLV's principal investigator for a nationwide study on the effectiveness of training simulators for OB/GYN surgical procedures. (Josh Hawkins/UNLV Creative Services)

Imagine you’re a patient about to undergo surgery, and you find out that your surgeon has only performed the surgical procedure you require once prior to you.

It doesn’t exactly put one at ease.

For quite some time, though, surgeons were trained through the “see one, do one, teach one” method, said Dr. Nadia Gomez, a researcher in the UNLV School of Medicine. See a particular surgery performed. Perform that surgery once yourself. Then teach someone else to do that procedure. Recognizing the limitations of that traditional teaching method, surgical training programs now require participants to practice procedures through simulations involving box trainers, computerized models, animal models, and human cadavers.

The quality of such simulations varies, however. While simulations for OB/GYN surgical procedures—procedures exclusive to women—exist, they are less developed and are studied less frequently than those affiliated with general surgeries.

To address this issue, the world’s largest association of gynecologic surgeons, the American Association of Gynecologic Laparoscopists, launched a nationwide study to incorporate and test the effectiveness of two simulators that are specific to female reproductive tract procedures — a laparoscopic simulator and a hysteroscopic simulator — with the goal of providing OB/GYN residents with a standardized assessment tool specific to their specialty that can be incorporated into their residency training.

The UNLV School of Medicine was one of three pilot sites selected to participate, with Gomez as UNLV’s principal investigator. UNLV’s OB/GYN residents are among the first to test out the hysteroscopic and laparoscopic simulators used in the study, which also includes participants from Harvard Medical School, John Hopkins, Vanderbilt University Medical Center, Northwestern University, and others.

“Objective surgical education in gynecology has been lacking,” Gomez said. “This study is crucial to the development of a validated gynecologic-specific surgical curriculum, and we are honored to be a contributor to this milestone in women’s health care.”

The general surgery field has led the charge on the incorporation of surgical simulation training into the curriculum. In 2008, the American Board of Surgery mandated that all general surgery residents pass the only validated laparoscopic surgical training curriculum available, the Fundamentals of Laparoscopic Surgery (FLS), to be eligible for the general surgery board examination. In January 2018, the American Board of Obstetrics and Gynecology announced that all OB/GYN residents graduating after May 31, 2020, would also be required to pass the FLS curriculum to be eligible for OB/GYN board certification.

This was a good start, Gomez said, but was not in itself enough to prepare residents for addressing women’s specific and unique surgical needs, which vary greatly from men’s.

“Although the FLS is a great curriculum for OB/GYN residents, it is not comprehensive,” Gomez said. “OB/GYN surgical training includes not only laparoscopic surgery but also hysteroscopy training, a procedure in which a small camera is inserted into the uterus to diagnose uterine problems. Women’s health needs include the management of fibroids, infertility, ovarian cysts, and other issues of the female reproductive tract, and the FLS curriculum is not specific to those things.”

OB/GYN physicians typically undergo a four-year residency training program during which they acquire the surgical skills needed to treat women with these types of health conditions, Gomez said. Some OB/GYN graduates like herself undergo further surgical training to specialize in areas such as gynecologic oncology, infertility, pelvic female reconstructive surgery, and minimally invasive gynecologic surgery (MIGS).

It was during Gomez’s two years of MIGS training that she was exposed to advanced gynecologic surgery training, including surgical simulation training and research. It changed her perspective on surgical training entirely.

“It is challenging to teach residents during live surgery because of patient safety issues and time restraints,” she said, “so I am a big supporter of simulation-based surgical training. It elevates and standardizes the surgical skills needed to give women the best surgical outcomes.”

Preliminary data from the study will be analyzed and published later this year.