ABSTRACT
Objective: To improve training for all obstetrics and gynaecology trainees in Northern Ireland (NI) through access to an agreed simulation programme. Design: Laparoscopic simulation leads were identified in all training units within NI. A regional laparoscopic simulation programme was designed and reviewed by all units to ensure a regional approach was maintained. Laparoscopic boxes were provided to all units alongside a curriculum document to follow. Method: Laparoscopic simulation leads were identified in all training units. A detailed curriculum was developed which ranged from basic to intermediate and advanced laparoscopic skills. All units were provided with laparoscopic simulation boxes to use throughout the 10 week programme. The teaching sessions were held on alternate Friday afternoons over a 20 week period as part of the regional CME programme within NI. This was part of the restoration of gynaecological surgical training in response to the challenges raised by COVID-19. Each week began with a lecture (delivered virtually) was given on the following topics;Theatre set up and equipment Ergonomics in laparoscopy Laparoscopic instruments and electrosurgery Pelvic anatomy Laparoscopic entry techniques Laparoscopic adnexal surgery Laparoscopic hysterectomy Laparoscopic urogynaecology Specimen retrieval Laparoscopic complications Each lecture was then followed by time spent using the laparoscopic simulation boxes under direct consultant supervision. A laparoscopic skills log book was designed to log all procedures performed by trainees including space for consultant feedback. A post course questionnaire was completed by trainees. Conclusion: COVID-19 has significantly impacted training and this programme has addressed concerns voiced by trainees and has made access to simulation training available to all trainees throughout NI. With consultant supervision and the use of an agreed curriculum and log book this has been a welcomed introduction with limited time spent in a live theatre environment. As this was held in each individual unit throughout NI all COVID regulations were met and good quality teaching in the trainees current training unit. This not only simulated laparoscopic skills but also the consultant supervision and feedback they would have experienced in theatre.
ABSTRACT
Design: Training in gynaecological skills has been significantly impacted by the COVID-19 pandemic. The RCOG recommended a training impact assessment of trainees as part of the gynaecological surgery recovery plan. A regional survey was designed in Northern Ireland (NI) to assess trainee's attitudes and exposure to current training in gynaecology and future plans for advanced training in gynaecology. Methods: The RCOG gynaecology recovery plan was discussed at the NI deanery school board meeting and an online training impact survey was developed. The survey was then sent to all obstetrics and gynaecology trainees within NI. The results were reviewed and presented back to the NI deanery school board. All units within NI were given access to the results with the aim to adopt a regional approach to improving training opportunities in gynaecology within NI. Results: 39 responses have been received to date from all levels of trainees and all 8 training units within NI. The results for rating current training in gynaecology were;very poor 8%, poor 44%, fair 36%, good 6% and very good 6%. An average of 3 gynaecology clinics were attended in the previous 8 weeks. Only 14% felt their skills were appropriate for their training grade. For attendance in gynaecology theatre sessions;44% <1 per month, 36% 1-2 per month, 17% 1 per week and 3% >1 per week. For proportion of time spent as the lead operator in gynaecology theatre only 33% of trainees were lead operator for >50% of cases. For procedural competence;50% diagnostic laparoscopy, 17% operative laparoscopy, 11% hysterectomy (abdominal, laparoscopic and vaginal 11% each), 19% vaginal repair and 31% laparoscopic management of ectopic pregnancy;64% required gynaecological summative OSATs in this training year;19% were doing a gynaecological ATSM of which 57% felt they would complete;78% of all responders felt they would not be competent at gynaecological surgery by the end of training. Conclusion: COVID-19 has had a clear effect on training in gynaecology and this is evident in all training units throughout NI for all grades of trainees. Trainees are concerned regarding their exposure to gynaecological training and their competence in the future as consultants. Other methodologies for training could be adopted in this time, including simulation, to help improve opportunities.