The role of simulation training for ob/gyns

Dr. Ascher-Walsh: Simulation has become much more popular.  It’s a very popular subject because of the fact that within our field there is not a good way of being assured that surgeons are maintaining their skills. So, unlike pilots who have to, on a yearly basis, go through simulation training to make sure they’re maintaining their skills, once your ob/gyn has graduated from residency and gotten appointed to a hospital, there really isn’t a way to make sure that they maintain their skills over their career. We are in a field where there are many gynecologists, who maybe do on average a dozen surgeries a year, which to many wouldn’t be enough to actually maintain their skills.

We think it’s important to come up with a way to prove, both for the safety of the patients, but also for the safety of the institution, and frankly for the safety of the surgeons, that they’re able to do what they’ve been credentialed to do. Simulation is the simplest way to start with that. We’re looking at ways of validating using simulation as a tool to maintain credentialing.

We’re still in the research phase; we recently published our pilot study just trying to correlate using simulation with actual surgical experience. We’ve shown that the more volume you do, the more training you have, the better. Good scores in simulation correlate with good scores on a live patient and we’re starting to take that to the next level. Now we’re doing actual procedures under simulation to show that that correlates – not just simple things like peg transfer or cutting and tying. If we show that that correlates, then we’ll actually compare simulation to live surgery. If we show that that correlates, the next step would be to have physicians, every year or two years, go through the simulation. If they don’t score at a high-enough level, then they’ll have to do some remedial training to be able to maintain their credentials.

Personally, I think this is something that ACOG will eventually take on the role of. While initially, it will be individualized by institution, we’ll have our own requirements. But frankly, if the public finds out that their surgeons don’t have any ongoing credentialing process, that’s sort of a frightening thing, honestly. You want to make sure that your pilot is up-to-date on all the new tools in the cockpit and the new technology they have; it should be the same for surgeons.

Charles J Ascher-Walsh, MD is an associate professor of obstetrics, gynecology and reproductive sciences; the Director of the Division of Gynecology, Director of the Division of Urogynecology, and Director of the Division of Minimally Invasive Surgery in the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, New York.