Elsevier

Journal of Surgical Education

Volume 73, Issue 5, September–October 2016, Pages 906-918
Journal of Surgical Education

Original Reports
Training and Assessment of Hysteroscopic Skills: A Systematic Review

https://doi.org/10.1016/j.jsurg.2016.04.006Get rights and content

Objective

The aim of this systematic review was to identify studies on hysteroscopic training and assessment.

Design

PubMed, Excerpta Medica, the Cochrane Library, and Web of Science were searched in January 2015. Manual screening of references and citation tracking were also performed. Studies on hysteroscopic educational interventions were selected without restrictions on study design, populations, language, or publication year. A qualitative data synthesis including the setting, study participants, training model, training characteristics, hysteroscopic skills, assessment parameters, and study outcomes was performed by 2 authors working independently. Effect sizes were calculated when possible. Overall, 2 raters independently evaluated sources of validity evidence supporting the outcomes of the hysteroscopy assessment tools.

Results

A total of 25 studies on hysteroscopy training were identified, of which 23 were performed in simulated settings. Overall, 10 studies used virtual-reality simulators and reported effect sizes for technical skills ranging from 0.31 to 2.65; 12 used inanimate models and reported effect sizes for technical skills ranging from 0.35 to 3.19. One study involved live animal models; 2 studies were performed in clinical settings. The validity evidence supporting the assessment tools used was low. Consensus between the 2 raters on the reported validity evidence was high (94%).

Conclusions

This systematic review demonstrated large variations in the effect of different tools for hysteroscopy training. The validity evidence supporting the assessment of hysteroscopic skills was limited.

Introduction

Hysteroscopy has become invaluable in gynecological practice by providing direct endoscopic visualization of the uterine cavity.1 Hysteroscopy can be used for diagnostic and therapeutic purposes; to investigate abnormal uterine bleeding, infertility, neoplastic areas; and to perform endometrial ablations and resections of intrauterine pathologies.2 Most hysteroscopic procedures are low risk and can be performed in an outpatient setting3, 4, 5; nonetheless, operative hysteroscopic experience is essential for the prevention of procedure-related complications.6, 7, 8, 9, 10

Both gynecologists and graduating residents acknowledge the importance of gynecologic endoscopy skills, including hysteroscopic skills.11 Similar to learning other surgical techniques, there is a need for thorough practice of hysteroscopy in the published literature, and several training curricula have been proposed.12, 13, 14, 15, 16, 17, 18, 19, 20

Performance of the hysteroscopic procedure is associated with certain technical challenges, including the fulcrum effect, loss of binocular vision, limited haptic feedback, and decreased mobility because of fixed access when performing hysteroscopy.21 Therefore, comprehensive training programs must be developed based on evidence with ongoing systematic feedback and assessment of competence.22, 23 Although challenging, hysteroscopic performance improves with training,24 and training also provides increased learning and retention.25, 26, 27 Assessment tools with sufficient validity evidence are necessary to provide feedback during training (i.e., formative assessment) and for certification (i.e., summative assessment).28, 29 Furthermore, assessment tools can be used to measure the effect of new training interventions, such as simulation-based training.30

The purpose of this review is to identify and systematically summarize existing evidence on hysteroscopic training and assessment.

The research question is: What is the current evidence on hysteroscopic training and assessment?

Section snippets

Material and Methods

The systematic review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses statement.31

Study Selection

A total of 324 records were identified, of which 269 remained after removal of duplicates (Fig.). In addition, 4 records were retrieved from the authors’ own records24, 35, 36, 37 (2 conference papers from www.virtamed.com 24, 35 and 2 conference papers from Journal of Minimally Invasive Gynecology36, 37). The predefined inclusion and exclusion criteria and screening of titles and abstracts led to the exclusion of 231 records. Eligibility was assessed for 42 records, including 7 conference

Discussion

The current systematic review sums up the different hysteroscopic training and assessment tools, which have been described to date. Only 26 studies were identified.

The majority of the studies focused on VR simulators (Table 1). Nevertheless, only a limited number of VR training models were presented, and these focused on sterilization procedures. Furthermore, only 3 studies described comprehensive training curricula with both theoretical and technical components. The remaining studies used

Conclusions

Published studies on hysteroscopy training and assessment have demonstrated limited study samples with large variations in the study designs and contents. Overall, the studies have presented consistent findings that increased training is correlated with improved performance, but the training interventions considered were not uniform and the assessment tools used to assess trainee competence were not supported by sufficient validity evidence.

Acknowledgments

The authors would like to thank Henrik Hornemann, librarian at the Copenhagen University Library, Denmark, for his support with the search string development. No funding was provided for this support and no conflict of interest existed.

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