The Impact of Simulation on Clinical Outcomes and Surgical Performance By Obstetric and Gynecology Trainees: A Systematic Review

STUDY OBJECTIVE: The value of simulation to develop specific skills in a controlled environment is well established among surgical specialties. It is unknown whether such skills transfer to clinical settings. The aims of this review are: 1. to determine if simulation training translates to improved surgical performance by Obstetric/Gynecology (OBGYN) trainees in operative settings; 2. to determine impact of simulation on clinical outcomes. DESIGN: MEDLINE, EMBASE, Cochrane, ERIC, and Psychinfo databases were searched through October 2019 to identify studies evaluating the use of simulation among OBGYN trainees. Studies were included if they assessed trainees’ skills in real surgical cases by objective measure after implementation of simulation training. Studies assessing only simulator performance were excluded. SETTING: N/A PATIENTS OR PARTICIPANTS: OBGYN trainees. INTERVENTIONS: Simulation training. MEASUREMENTS AND MAIN RESULTS: 457 abstracts were screened and 16 included in the final analysis. Most studies used an Objective Structured Assessment of Technical Skills (OSAT) or modified version during laparoscopic salpingectomy or tubal ligation. Ten studies found performance improvement after simulation training. Fewer studies assessed impact on clinical outcomes. Of these, half noted a decrease in operative time with simulation. Length of stay was found to significantly decrease; however, no significant difference in other clinical outcomes was noted following simulation. Most trainees reported satisfaction and self-perceived increase in surgical skills following simulation training. CONCLUSION: This is the first systematic review to evaluate the translation of gynecologic surgical skills to the operating room following simulation training. Skills developed through simulation appear to be transferable to the operating room. More numerous studies are needed to better assess effects on clinical outcomes and whether findings hold true with increasing case complexity.