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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 hysterectomy.   

Topics: 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,

General Information

Student,Resident,Faculty,Clerkship Director,Clerkship Coordinator,Osteopathic Faculty,Residency Director,Residency Coordinator,
Medical Knowledge,Systems-Based Practice & Improvement,Practice-Based Learning & Improvement,
Simulation,Problem-Based Learning,
Clinical Focus
Minimally Invasive Surgery,

Author Information

Jonathan Jones, MD, University of South Alabama; Fang Weng, MD; Hayden Kassels, MD; Tracy Roth, MD; Katherine Grette, MD

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