Completed vaginal surgery education trial and local implementation into our residency program

We are pleased to report that our PROcedure-specific MOdular Training and Evaluation randomized controlled trial (PROMOTE), led by principal investigator Dr Roxana Geoffrion over the past decade, is completed and recently published. This research produced the first ever fully validated vaginal surgery training curriculum, successfully implemented in the first junior Obstetrics and Gynecology resident cohort at the University of British Columbia this year.

Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents’ confidence and preparedness for vaginal surgery has plummeted in the past decade. We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair, vaginal hysterectomy, recruiting novice gynecology residents. We evaluated performance via global rating scale in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.

Based on results of the PROMOTE trial, Dr Hanna Ezzat, the Obstetrics and Gynecology residency program director at UBC, facilitated implementation of a vaginal surgery training curriculum into routine resident education at the Foundations of Discipline level. The curriculum consists of a didactic portion, followed by a multiple choice test; supervised training on low fidelity simulation models and independent practice, followed by post-intervention testing of timing and error scores on the models.

Eight residents obtained protected time and participated in the curriculum over a period of two months, guided by six faculty preceptors and one proctor trained to administer the PROMOTE tests and score performance. All residents completed and passed their final evaluation. Their feedback will be invaluable for future cohorts.

REFERENCE: Geoffrion, R., Koenig, N. A., Cundiff, G. W., Flood, C., Hyakutake, M. T., Schulz, J., Brennand, E. A., Lee, T., Singer, J., & Todd, N. J. (2024). Procedure-specific simulation for vaginal surgery training: A randomized controlled trial. Acta obstetricia et gynecologica Scandinavica, 10.1111/aogs.14810. Advance online publication.