Abstract:

Introduction:
Modern practical gynecology requires mandatory diagnostic and therapeutic hysteroscopic (HS) procedures. Their high-quality and safe performance is due to repeated trainings for mastering motor skills. This should ultimately lead to a tactile sensation and understanding of depth, fulcrum and force of impact. Simulation training is especially important, which gives effective theoretical and practical training of novice gynecologists for basic HS manipulations, the ability to conduct and evaluate their teamwork. The virtual simulator is widely used for objective assessment of clinical skills and abilities associated with the competence.
Objective:
To evaluate the implementation results of quality assessment and assurance of obstetrician-gynecologists’ training using a virtual HS simulator.
Materials and methods:
During 4 years 156 obstetricians-gynecologists underwent "HS with resectoscopy" (72 hours) training in small groups up to 8 people in the simulation medicine department of Odessa National Medical University.
After short lecture course the trainees practiced HS skills using conventional mechanical HS instruments used in clinics. Diagnostic HS was practiced (mastering the technology and specifics of conducting, examining cavities, photographing, etc.). Technique of hysteroresectoscopic operations: taking tissue samples, mechanical polypectomy, dissection of synechia and intrauterine septum, removal of small submucous nodes was carried out using a virtual feedback haptic simulator VirtaMedHystSim (Simbionix, Israel).
The initial and final anonymous self-assessment questionnaire of qualification characteristics, which we developed, for their practical skills in carrying out HS was filled out.as well as theoretical knowledge level. We also used before and after training the well-known methodology for teaching and testing HS skills (HYSTT) - a practical test for measuring the level of competence of a trainee in the field of basic HS psychomotor skills in the uterine cavity, which mainly assesses video camera navigation and hand-eye coordination. We also developed a test card that takes into account the effectiveness of cadets' teamwork, which was also studied at the beginning and at the end of the cycle
Results:
More often doctors with work experience of up to 5 and over 20 years were trained. Almost half did not have a qualification category, and only 9.5% hold an academic degree. 75% have never performed HS in practice.
At the beginning of the cycle the average number of self-assessment points among trainees was 30.2, and after training - 59.9 (p <0.001) (maximum was 80) proving they felt much more confident in performing practical skills.
The average score during outgoing testing was 3.7, and the final - 4.6, which testified to theoretical knowledge significant improvement (p <0.001).
For the teamwork effectiveness assessment the average grade was 2.8, and after training it significantly increased to 4.8 (p <0.001).
Conclusions:.
After completion the training course of HS using both theory, real instruments, virtual 3D haptic techniques the level of practical skills, cadets’ self-esteem, theoretical knowledge level, teamwork effectiveness have increased significantly. That complex educational curriculum quantifies the skills required to perform hysteroscopy and makes it necessary for the quality assessment and assurance of obstetrician-gynecologists’ not only training but every day’s work with real patients.

Keywords:

Obstetrician-gynecologist, hysteroscopy, 3D, virtual realty, haptics, quality assessment, quality assurance, simulation training, postgraduate training.