Piloting the Fundamentals of Vaginal Surgery on Low-Cost Simulation Models

Objectives: As rates of vaginal hysterectomy continue to decline, trainee confidence and skills are decreasing, particularly in low-resource settings. Simulation-based education is a well-established modality in surgical education. The Fundamentals of Vaginal Surgery (FVS) is a simulation-based hands-on curriculum that was developed to teach trainees vaginal surgery. The goal of this pilot study was to incorporate FVS tasks into a low-cost self-made vaginal surgery partial task trainer and to use a self-assessment tool to guide learners through self-practice.

Methods: Our low-cost simulation model was modified from a previously developed vaginal surgery simulation model endorsed by ACOG’s Simulation Consortium. The model cost less than twenty dollars to build and consisted of materials acquired from standard surgical operating rooms. A plastic cup is attached to the pegboard which simulates performing surgery in a deep space. Inserts were then placed into the cup and adapted to perform the 6 FVS skills tasks. OBGYN residents participated in a 2-hour simulation in which they watched instructional videos created by FVS and self-practiced each of the 6 FVS tasks. They then completed a self-assessment questionnaire developed for this project measuring perceived learning gains for each of the 6 tasks. Questions assessed perceived learning gains by using a 7-point Likert scale.

Results: 16 residents participated in the simulation with participants from all four years of training (PGY1 38%, PGY2 25%, PGY3 13%, PGY4 25%). Overall, the simulation was perceived as very useful with 94% of respondents rating the workshop as such on the self-assessment tool. Most residents perceived that they made moderate learning gains with one and two-handed knot-tying tasks (31% and 44% respectively), and when performing a running suture (40%), Heaney transfixion suture (33%), and free pedicle ligation (25%). The majority of residents (47%) rated their learning gains as somewhat large for performing a plication suture. Overall scores were concentrated between moderate to large learning gains for each of the 6 tasks.

Conclusions: This pilot study demonstrated the feasibility of implementing the FVS curricula for OBGYN residents when using a low-cost vaginal surgery partial task trainer. The self-assessment tool demonstrated moderate to large learning gains in this self-guided, task-based simulation workshop. Future validity work can explore its potential in expanding vaginal surgery training by making it more accessible in low-resource settings and promoting self-guided learning.