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Understanding Anatomy Through Surgical Simulation; A Quality Improvement Project in Resident Education
Purpose: To increase resident understand and comfort in pelvic surgery
via a novel yet easily replicated simulation of a vaginal hysterectomy.
Background: Pelvic anatomy has long been a hurdle for OBGYN
residents to overcome during their time in residency. Proficiency comes as a
direct result of hands-on learning through repetitive experience in a
procedure. The COVID-19 pandemic affected OB/GYN residency experience; surgical
volume decreased, universities placed restrictions on in person cadaver labs,
and many 2020 graduates struggled to meet minimum requirements.
Innovative solutions are needed to continue resident surgical education and
ensure competency. We developed a novel and inexpensive model for vaginal
hysterectomy simulation to enable our residents to learn anatomy while
practicing surgical skills.
Methods: A novel vaginal hysterectomy simulation was developed
to reinforce topics such as the ligament fixation, control of blood supply, and
operating in a narrow field. The model was constructed out of chicken thighs
(uterine corpus and cervix) and pork stomach (broad and cardinal ligaments) and
suspended in a plastic cup (vagina). Residents were then able to complete
a “vaginal hysterectomy” using the model, with faculty assistants identifying
the relative location of important structures and critiquing performance of key
techniques like Heaney fixation on the uterosacral and double ligation of the
utero-ovarian vessels. After the simulation was completed, residents completed
a satisfaction survey about their experience with the model.
Results: The simulation was conducted with excellent immediate
feedback. Fourteen residents completed the survey. All respondents
answered “agree” (n=2) or “strongly agree” (n=12) when asked if they preferred
simulation based anatomy to a traditional lecture format, and also when asked
if they would recommend simulation based anatomy vs. cadavers/prosections.
Likewise, all respondents “agreed” (n=4) or “strongly agreed” (10) that the
simulation improved their understanding of relevant anatomy. 11 residents
“strongly agreed” the simulation improved their comfort with the steps of the
procedure. 2 “agreed” and 1 was “neutral”.
Discussions: Surgical simulation is an effective means to educate
residents in pelvic anatomy, and low-cost models like this are an important
part of surgical skill development. OB/GYN residencies should consider adopting
this affordable, easily replicated method for instruction in vaginal
CREOG & APGO Annual Meeting, 2022, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Problem-Based Learning, Minimally Invasive Surgery,