A SIX-YEAR STUDY OF SURGICAL TEACHING AND SKILLS EVALUATION FOR OB/GYN RESIDENTS

G.M. Lentz, L.S. Mandel, B.A. Goff

University of Washington School of Medicine, Seattle, WA

OBJECTIVE: To evaluate an ongoing surgical skills teaching and objective testing program of OB/GYN residents and assess the impact of a complete 4-year surgical curriculum.

MATERIALS AND METHODS:  From 1997 through 2002 we conducted twice-yearly surgical skills training sessions for 24 OB/GYN residents, using both inanimate models and animal labs.  Once a year we conducted formal testing and objective structured assessment of technical skills (OSATS) with all residents attempting six surgical tasks.  Testing included bench tasks, life-like models and pig labs. Checklist and global ratings were performed by faculty, some of who were blinded to resident year.  We compared residents who had all 4 years of training with those who started residency earlier and had only 1 or 2 years of the new curriculum.  We also compared residents’ own performance from year to year and cohort performance by resident year. One-way ANOVA and independent t-tests were utilized for analysis.

RESULTS:  Regarding bench skills, R3 and R4’s who had 3-4 years of surgical lab training did significantly better than R3 and R4’s with fewer years of training sessions (total scores of 47.5 vs. 36.6, p=.002). Senior residents with complete training performed significantly better on both open and laparoscopic bench tasks than did those with less training:  open—23.3 vs. 12.7 (p<.001); laparoscopic—21.8 vs. 14.9 (p=.021).  Over 4 years, open skills appeared to improve more than laparoscopic. As a result of varying the OSATS tested each year, there were 3 tasks done consistently.  No significant difference was found in checklist or global scores for laparoscopic salpingotomy or laparotomy salpingo-oophorectomy among resident cohorts regardless of number of training sessions. However, for R4s there was a trend toward higher scores with increased training although the numbers were too small to reach significance. Laparoscopic suturing was significantly better on global OSATS in R3 and R4s who had complete lab training compared with R3 and R4s with fewer training sessions (28.4 vs. 22.5, p=.005). Total OSATS global scores improved as residents (n=72) progressed through the program: R1=107, R2=130, R3=167, R4=182 (R1<R2<R3<R4, p<.001). When comparing residents’ own performance over 4 years, both checklist and global scores improved significantly on laparoscopic salpingotomy (p<.001). Resident training evaluations were consistently favorable—4-5 out of 5 over 6 years.

CONCLUSION:  Resident surgical skills evaluated by bench tasks and OSATS significantly improved over time both individually and as a cohort by resident year. After 6 years of running a surgical skills training program, there was a trend toward improvement in ability to perform tasks with completion of the 4-year curriculum, but because of small numbers and the variability of each cohort, significance was only shown with one task. Residents highly valued the lab surgical training.

Key Words: surgical training, OSATS

Disclosure – Grant/Research: G.M. Lentz, US Surgical; L.S. Mandel, US Surgical, Ortho-Biotech;  B.A. Goff, US Surgical, Ovarian Cancer Research Fund, APGO-Ortho McNeil Faculty Development Award, Lilly Oncology, GlaxoSmithKline; Consultant/Speakers Bureau: G.M. Lentz, Pfizer.