A randomized controlled trial comparing traditional with simulation resident surgical laparoscopic salpingectomy training

Study Objective: To evaluate the effectiveness of the porcine training model for obstetrics-gynecology residents in laparoscopic salpingectomy. Design: Randomized controlled single blinded trial. Setting: A large tertiary care hospital. Patients: Twenty-two PGY-1 through PGY-4 OB GYN residents were enrolled. Intervention: Residents were randomly assigned, in blocks of two stratified by experience, to the intervention or control group. All participants underwent a pre-intervention objective skills assessment test (OSAT), in which the participant performed live (human) laparoscopic salpingectomy which was video-recorded. A subjective survey assessed participants' comfort levels. The intervention consisted of a simulation session involving pre-session reading, a lecture, viewing a procedural video, and practicing laparoscopic salpingectomy on a porcine cadaver. The control group received traditional training. All participants underwent a postintervention OSAT and a second subjective survey. All recorded salpingectomies (OSATs) were scored by a single blinded evaluator. Measurements and Main Results: Nine OSAT surgical skills and 10 subjective measures were assessed using a Likert Scale of 1 -5 (for (Graph presented) OSATs 1=low score, for subjective 1=high score). Control group OSAT scores did not change (pre: 26.6±10.8, post: 26.2±10.1, p=.65). The intervention group showed significant improvement in two-handed surgery (pre: 2.8±1.6, post: 3.5±1.3, p=.004) and use of energy (pre: 2.9±1.3, post: 3.6±1.0, p=.01), contributing to the overall score change (pre: 26.7±10.6, post:29.9±9.8, p%.001). The control group experienced no change in comfort levels. The intervention group experienced both increases (anatomy, steps of surgery, two-handed surgery, and use of energy) and decreases (reading and learning in OR) in comfort levels. Conclusion: This study demonstrates that simulation can improve surgical technique. However, of 45 possible OSATs points, both groups' average scores were<70% correct despite the intervention. Thus, the gain, while statistically significant, was relatively small and indicates that resident training should be supplemented to increase the baseline level of surgical skills.