Formation chirurgicale des internes, spécialistes en gynécologie-obstétrique : résultats d’une enquête électronique nationale

Objective assessment of obstetrics residents' surgical skills in caesarean: Development and evaluation of a specific rating scale

OBJECTIVE

To develop a modified version of Objective Structured Assessment of Technical Skill (OSATS) rating scale for evaluation of surgical skills specific to caesarean and to assess its relevance in documenting the residents' learning curve during their training. Secondarily, to verify the scale's stability to caesarean's level of difficulty and comparing self-assessment to hetero-assessment in order to propose a practical application of this rating scale during residency.

STUDY DESIGN

We conducted a multicentre observational prospective study, from May 2018 to November 2018. All residents at that time could participate and fill in the rating scale after caesarean. Senior surgeons had to fill in the same rating scale. We analysed correlation between self-assessments and hetero-assessments and sensitivity to change of the rating scale. Analysis of feature's relevance was performed by principal component analysis, factor analysis and reliability analysis.

RESULTS

In total, 234 rating scales were completed evaluating 18 residents. Our study demonstrated that our rating scale could be used to evaluate surgical skills of residents during caesarean and distinguish their year of residency (p < 0.001) with a high correlation between self and hetero-assessment (Intraclass Correlation coefficient for global score: 0.78; 95% CI 0.68-0.86). The principal component analysis revealed two dimensions corresponding to the two parts of the rating scale and the factorial analysis allowed us to confirm distribution of features according to these two dimensions. Cronbach's alpha allowed us to highlight the percentage of representation of the scale's features in relation to all potential theoretical features (0.93, 95% CI 0.82-0.95).

CONCLUSION

Our rating scale could be used for self-assessment during residency and as a hetero-assessment tool for validating defined stages of the internship.

Gynecology-obstetric resident surgery training: a national evaluation

OBJECTIVES

The main objective of this study was to evaluate surgery training and evaluation of French gynecology-obstetrics residents. The second objective was to evaluate using simulation during residency.

STUDY DESIGN

This national descriptive study, utilized a questionnaire to survey all interns in French gynecology and obstetrics. At the end of a study, 129 responses of residents were analyzed.

RESULTS

The participation rate was 12%. The majority of residents were women (84%) and the highest response rate was from the Ile-de-France region (36%). The lowest rate was from the Southern region. The majority of residents were in the eighth semester (20%). Residents reported surgical and obstetric orientations in 53% (n = 68) and 44% (n = 57) of cases, respectively. Registration for cancer oncology was reported by 22% (n = 28) of respondents. Evaluation of oncologic surgery training was mostly considered "good" by the surgical group and "passable" by the obstetrics group. Access to simulators was usually restricted and most often utilized the pelvitrainer. Sessions were typically not mandatory and numbered between zero and five per semester. Three types of simulators were accessible in the Ile-de-France, North-West, West and Rhône-Alpes. The North-East did not have access to animal models, and the South-West did not have access to corpses. Surgical classes were more common in the Rhône-Alpes, North-East, Ile-de-France and North-West regions. To improve their training in oncological surgery, 64% (n = 18) of residents planned to do an inter-university exchange and 54% had completed additional specialized training. Measures that were most expected to improve training were increased training in surgery (96% of respondents, n = 27) and more intensive coaching (96%, n = 27).

CONCLUSIONS

Companionship is a pillar of residents training, but its effectiveness is variable. One solution could be to implement better use of simulation methods.

Comparing technical dexterity of sleep-deprived versus intoxicated surgeons

Background:

The evidence on the effect of sleep deprivation on the cognitive and motor skills of physicians in training is sparse and conflicting, and the evidence is nonexistent on surgeons in practice. Work-hour limitations based on these data have contributed to challenges in the quality of surgical education under the apprentice model, and as a result there is an increasing focus on competency-based education. Whereas the effects of alcohol intoxication on psychometric performance are well studied in many professions, the effects on performance in surgery are not well documented. To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists “under 2 conditions”: sleep deprivation and ethanol intoxication. We hypothesized that the performance of unconsciously competent surgeons does not deteriorate postcall as it does under the influence of alcohol.

Methods:

Nine experienced staff gynecologists performed 3 laparoscopic tasks in increasing order of difficulty (cup drop, rope passing, pegboard exchange) on a box trainer while sleep deprived (<3 hours in 24 hours) and subsequently when legally intoxicated (>0.08 mg/mL blood alcohol concentration). Three expert laparoscopic surgeons scored the anonymous clips online using Global Objective Assessment of Laparoscopic Skills criteria: depth perception, bimanual dexterity, and efficiency. Data were analyzed by a mixed-design analysis of variance.

Results:

There were large differences in mean performance between the tasks. With increasing task difficulty, mean scores became significantly (P < .05) poorer. For the easy tasks, the scores for sleep-deprived and intoxicated participants were similar for all variables except time. Surprisingly, participants took less time to complete the easy tasks when intoxicated. However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived. Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task.

Conclusions:

Being intoxicated hinders the performance of more difficult simulated laparoscopic tasks than being sleep deprived, yet surgeons were faster and performed better on simple tasks when intoxicated.

[Assessment of shoulder dystocia related knowledge among French obstetrics and gynecology residents]

OBJECTIVE

To study the related knowledge of French residents in obstetrics concerning maneuvers for shoulder dystocia (SD).

MATERIALS AND METHODS

Multicenter descriptive transversal study conducted from June to September 2014. Data collection was performed through questionnaires sent by email to French resident in obstetrics.

RESULTS

Among the 1080 questionnaires sent, 366 responses were obtained with a response rate of 33.9%. One hundred and forty-three residents (39.1%) were in the first part of their training (≤5th semester) and 60.9% (n=223) were in the second part of their training. Theoretical training on the SD was provided to 88.2% of resident (n=323). In total, 38.8% (n=142) obtained their French degree in mechanical and technical obstetric and among them 77.5% (n=110) had the opportunity to train on simulators and dummies. Concerning their practical experiences, 31.5% (n=45) residents ≤5th semester reported having experienced SD during their residency vs 58.3% (n=130) amongst oldest residents (P<0.001). In the second part of residency, 40% of residents (n=89) expressed to feel able to manage shoulder dystocia. Only 19.1% (n=70) were satisfied with their residency training program vs 39.1% (n=143) who were unsatisfied.

CONCLUSION

Our study showed that less than one resident out of two (40%) felt able to perform maneuvers for SD in the second part of residency. We think that simulation activities should be mandatory for residency training programs in Obstetrics and Gynecology, which have to develop dependable measures to assess resident competencies to execute practical maneuvers for clinical emergencies in obstetrics.

[Residents in respiratory medicine: Assessment of the course and wishes regarding their career]

INTRODUCTION

The aim of this study was to assess the feelings of residents in respiratory medicine regarding the quality and organization of their training and towards their career prospects.

METHODS

A prospective survey conducted over the Internet among all the members of the French Young Pulmonologists Association (AJPO2).

RESULTS

One hundred and thirty-two (71.5%) members responded. The rating given to theoretical training was 6 [5-7] whereas the practical training was rated at 7 [6-8] out of 10. The majority of the residents considered that the length of their course should be adapted (80.3%). Of them, 74.2% wanted to add a mandatory semester. The proposed mandatory semester was in bronchoscopy (40.3%). Seventy-two percent of the resident wanted to acquire a specialisation, the most common of which was in oncology (36.6%). Among the residents, 96.2% wanted to conduct a fellowship. The main reason for this was their feeling of inability to correctly handle patients at the end of their residency. Of the residents, 55.3% were considering working in a public hospital.

CONCLUSION

There are opportunities to improve the French respiratory residency training both in its theory and practical aspects. The modalities of this training could also be adapted. Access to a fellowship is a major concern for the residents.

[Interest of a structured laparoscopy training in a simulation center: survey of resident's point of view]

OBJECTIVE

Assess residents satisfaction within their participation to a short and structured training to laparoscopy, gathering theoretical and practical issues.

METHODS

This course was divided in two periods of 3days including an individual prospective evaluation. For each period, the residents have answered to three questionnaires trying to evaluate their experience in laparoscopy and their short term and medium term satisfaction.

RESULTS

Three hundred residents from different French university hospitals have been involved in this study. After 4years, half of them were not satisfied with their chirurgical studies. Thirty-seven percent of them never attended to any surgical procedure as main operator. The training course has answered to their expectation for 95% of the residents and 85% said they now feel more confident about laparoscopy then before. According to 76% of them, it should be a compulsory and systematic training course and for 75%, they should be tested regarding their laparoscopy skills level during the resident studies period. The training on animals is the more efficient for 86% of them.

CONCLUSIONS

Due to the increasing number of residents and to the legal time for rest, the time spent in the operative room has decreased. People also do not accept easily the training made on true patients. Intensive and tested training are useful and answer to residents needs. They could be systematically integrated in their global curriculum.

A surgical virtual reality simulator distinguishes between expert gynecologic laparoscopic surgeons and perinatologists

BACKGROUND

Concern regarding the quality of surgical training in obstetrics and gynecology residency programs is focusing attention on competency based education. Because open surgical skills cannot necessarily be translated into laparoscopic skills and with minimally invasive surgery becoming standard in operative gynecology, the discrepancy in training between obstetrics and gynecology will widen. Training on surgical simulators with virtual reality may improve surgical skills. However, before incorporation into training programs for gynecology residents the validity of such instruments needs to first be established. We sought to prove the construct validity of a virtual reality laparoscopic simulator, the SurgicalSim(TM), by showing its ability to distinguish between surgeons with different laparoscopic experience.

METHODS

Eleven gynecologic surgeons (experts) and 11 perinatologists (controls) completed 3 tasks on the simulator, and 10 performance parameters were compared.

RESULTS

The experts performed faster, more efficiently, and with fewer errors, proving the construct validity of the SurgicalSim.

CONCLUSIONS

Laparoscopic virtual reality simulators can measure relevant surgical skills and so distinguish between subjects having different skill levels. Hence, these simulators could be integrated into gynecology resident endoscopic training and utilized for objective assessment. Second, the skills required for competency in obstetrics cannot necessarily be utilized for better performance in laparoscopic gynecology.