Correlation of surgical case volume and fellowship training with performance on simulated procedural tasks

Janine A. Doneza, Vijay Palvia, Veronica T. Lerner, Jessica Overbey, Mark Levie, Michael Brodman, Charles Ascher-Walsh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: High-volume and fellowship-trained surgeons have superior outcomes. However, in gynecology, a large proportion of cases are performed by low-volume surgeons. Simulation has been shown to be useful in assessing surgical skill and may be a useful tool in hospital credentialing and maintenance of privileges. Objective: To determine the correlation between a surgical case volume and fellowship training with performance on simulated procedural tasks. Study Design: A total of 108 obstetricians and gynecologists with laparoscopic privileges at 2 academic institutions completed a pre-test survey and performed 3 tasks on the LapSim laparoscopic virtual reality simulator. The pre-test survey inquired about the monthly laparoscopic case volume and prior training. Simulations included a basic skills task (peg transfer) followed by a procedural task (salpingectomy) of 2 difficulty levels (low and moderate). Spearman correlation and Wilcoxon tests were used to determine correlations between the survey responses and performance metrics. Results: Participants included 67 generalists (62%) and 41 fellowship-trained specialists (38%). There was an observed weak correlation among surgical volume (more than 6 cases per month), time to completion, and the amount of blood loss when performing the low-difficulty level salpingectomy (r=−0.32, P=.0007 and r=−0.29, P=.002, respectively). The economy of movement (instrument path length) was correlated to high surgical volume (r=−0.35, P=.0002). Compared with generalists, surgeons with fellowship training performed tasks faster (410.8 seconds [interquartile range, 309.7–595.2]) vs 530.2 seconds (interquartile range, 406.2–605.0; P=.0009), more efficiently at 6.1 m (interquartile range, 4.8–7.3) vs 8.1 m (interquartile range, 5.8–10.7; P=.0003), and with less blood loss at 21.7 mL (interquartile range, 11.8–37.7) vs 42.9 mL (interquartile range, 18.1–70.6; P=.002). Regarding the case volume and fellowship background, there was no difference in ovarian diathermy damage. In addition, there was no difference among most performance parameters for the peg transfer task and the moderate-difficulty salpingectomy procedure. Conclusion: Surgical experience obtained through higher case volume and fellowship training correlate with higher performance scores during simulated procedural tasks. In a previous study, we found a similar correlation with simulated basic skills tasks. The current study is a continuation of an ongoing quality initiative to establish a summative assessment of laparoscopic surgical skills using virtual reality simulator for the maintenance of credentials among obstetrical and gynecologic surgeons. Future studies will compare the performance metrics from laparoscopic procedures performed on virtual reality simulator with the performance in the operating room and clinical outcomes.

Original languageEnglish (US)
Pages (from-to)548.e1-548.e10
JournalAmerican journal of obstetrics and gynecology
Volume225
Issue number5
DOIs
StatePublished - Nov 2021

Keywords

  • clinical competence
  • credentialing
  • fellowship
  • gynecology
  • laparoscopic surgery
  • laparoscopy standards
  • maintenance of certification
  • physician standards
  • simulation training
  • surgery
  • surgical volume
  • validity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Fingerprint

Dive into the research topics of 'Correlation of surgical case volume and fellowship training with performance on simulated procedural tasks'. Together they form a unique fingerprint.

Cite this