Teaching Vaginal Surgery Through Simulation

As the volume of vaginal surgery declines, residents have fewer opportunities to learn, and training programs are incorporating simulation into their curricula to address this deficiency. We conducted a scoping review to identify literature on simulation training for gynecologic vaginal surgical procedures. Data were extracted from each study on the following parameters: model or assessment tool description, study objectives, target skill level, learning objectives, intervention, aims of the study, study outcomes, performance metrics, performance cutoff scores, simulator assessments, Medical Education Research Study Quality Instrument scores, and implementation factors. The literature search resulted in 5,560 articles. After deduplication, 3,140 titles were selected for review; of these, 2,953 titles were excluded, and 187 were selected for possible inclusion. Of the 41 included studies, 20 articles were relevant to vaginal hysterectomy training, two investigated assessment tools for vaginal surgical performance, 12 were relevant to prolapse surgery, six were relevant to incontinence sling surgical simulation, and one was relevant to vesicovaginal fistula repair. Simulation fidelity, complexity, cost, and evidence of educational effectiveness varied considerably across studies. Only a handful of studies reported proficiency cutoff scores or robust validity evidence. Practical considerations such as ease of use and accessibility were frequently addressed, but few studies evaluated the transfer of skills to the operating room or the effect of simulation training on patient outcomes. The available literature demonstrates both innovation and significant heterogeneity in educational methodology, assessment, and validity. Our narrative review summarizes and highlights information that surgical educators need on the ground to implement simulation training in vaginal surgery skills. Further research is needed to develop standardized assessment tools, to improve validity, and to evaluate the real-world translation of simulation to surgical competency and patient care.