Simulation effective in teaching difficult gynaecological procedures

Wednesday 23 August 2017

Simulation is effective in teaching difficult gynaecological procedures to doctors with different levels of expertise, a Mater Research study has found.

Simulation is increasingly being used in gynaecology for surgical training; however, most of the supporting research is in laparoscopic procedures.

Large loop excision of the transformation zone (LLETZ) is a common gynaecological treatment for pre-cancer changes of the cervix, but can be challenging to teach given the high degree of coordination and precision required.

Mater Researcher and Mater Mothers’ Hospital Obstetrician and Gynaecologist Dr Sarah Janssens said the LLETZ procedure is commonly performed under local anaesthesia in an awake patient.

“This can be a barrier to the free flow of verbal instructions to the trainee.  So we looked at developing a low cost simulator and wanted to learn if it could  improve physician’s skills to avoid either an excessive or an inadequate deep excision,” Dr Janssens said.

“The simulator was constructed using readily accessible materials such as a shoe box and gloves as well the usual clinical material necessary to perform  a LLETZ procedure”

The study evaluated the performance of the low cost LLETZ simulator by investigating the acceptability of the simulator to the learner and exploring their views on whether it could be an appropriate training tool.

“This preliminary evaluation demonstrates the low-fidelity LLETZ simulator to be realistic to participants, suitable for training and able to reflect the procedural skill of the users,” Dr Janssens said.

“The availability of simulation equipment can be a barrier to simulation training, and low-cost models may be more likely to be widely adopted. The LLETZ simulator we developed is low cost and could be used by a variety of institutions.”

Further research evaluating the relationship between simulator performance and real procedure performance and clinical outcomes, is planned.

The study is published in Simulation in Healthcare.

Dr Janssens received a Betty McGrath fellowship for this research, generously funded by Mater Foundation.