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    Simulation training for gynecologic surgery

    Simulation training is gaining acceptance as a complement to traditional ob/gyn surgical training and may prove beneficial as a presurgical "warm-up" for experienced surgeons.

    A paradigm shift is under way in the field of surgical education, with a transition away from the traditional apprenticeship model of medical training. The new surgical teaching model includes learning basic surgical skills, practicing on a model, watching videos and observing in the operating room, and performing a surgical procedure with feedback and evaluation.1 Simulation training has emerged as an alternate modality to augment traditional surgical training.

    The growth of simulation for gynecologic surgical training took its roots within residency programs in response to a decrease in patient availability for training. The decline in training opportunities resulted from several factors, including work-hour restrictions, increased subspecialization, growth of minimally invasive options, and financial and professional liability concerns. Since the advent of work-hour restrictions, there has been a decline in the total number of surgical cases for graduates of residency training programs. Furthermore, the practice of gynecology has evolved. With the advent of more interventional radiologic procedures and effective medical therapies, conditions that were previously treated surgically are now managed conservatively, further reducing the number of available cases for surgical training.

    The growth of minimally invasive and robotic surgery provides opportunities for less experienced surgeons to acquire knowledge. An increase in pelvic reconstructive surgery fellowships and advanced training programs in minimally invasive surgery has created competition among residents, fellows, and less experienced surgeons to acquire enough patients for training. In addition, the decrease in patient availability for training also may be a consequence of an increased emphasis on patient safety initiatives and cost efficacy in training.

    Many postoperative complications are the result of errors in intraoperative techniques.2 Surgical technique is a more significant predicator of morbidity and mortality than preoperative prognostic factors.3 Therefore, experienced surgeons may be more reluctant to allow the less experienced to operate.

    ACOG Simulations Consortium: What you need to know
    Surgical training is expensive because novices require more time to complete procedures. The operating room may not be the most cost-effective or ethical environment in which to learn surgical skills. As new procedures and technologies emerge, the need for learning new surgical techniques will not be limited to residents. Therefore, the evolution of our specialty, the decrease in patients available for training, patient safety initiatives, and financial pressures have all contributed to the growth of simulation training for gynecologic surgery. It seems logical that the role for simulation training for gynecologic surgery will inevitably expand beyond resident and fellow training to experienced surgeons learning new techniques and refining their skills on infrequently performed procedures. In anticipation of the need for more sophisticated training modalities, the American College of Obstetricians and Gynecologists created the ACOG Simulations Consortium (see sidebar article).

    Sarah L. Cohen, MD, MPH
    Dr Cohen is an Assistant Professor in the Department of Obstetrics and Gynecology and Director of Research for the Division of Minimally ...


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