The residency transition into the real-world OR environment can be challenging. Our goal is to prepare you for live procedures by orienting you to anatomy and technique using surgical simulation. The simulated environment gives you time to process through early development of technique and skill in a "cold action" practice environment (Eraut, 1985) before proceeding into the "hot action" of the operating room.

Our program currently begins each July with a two-day, eight-station Skills Camp experience where you learn and practice basic surgical component skills such as suturing, knot tying, incising skin without beveling, basic obstetrical exam for fetal vertex position, forcep and vacuum delivery. During Skills Camp, you will challenge yourself using objective measures of these skills.

Gynecological Surgery Simulation

In addition to component skill simulation, our gynecological surgery program provides surgical videos, simulation models, and an advanced pelvic anatomy course that takes place every other year. Our residents are expected to practice basic surgical skills until they are proficient.

Models available in our Medical Education Suite at Women’s and Children’s Hospital include laparoscopic video box trainers, suture sets, surgical videos, and laparotomy and vaginal hysterectomy models.

Obstetrical Surgery Simulation

In addition to gynecological procedure simulation, our residents participate in our Obstetric Emergencies Course  an extremely popular course given for a fee to obstetricians in private practice where they are given the opportunity to use our Noelle birth simulators to treat eclampsia, severe postpartum hemorrhage, precipitous vaginal breech delivery, etc.

Operative vaginal deliveries  both vacuum and forceps  are practiced using our high fidelity delivery simulator. This silicon pelvis is incredibly life-like, with anatomical landmarks such as pubic arch and spines, and allows for realistic forceps and vacuum simulation.

Repair of 3rd and 4th degree lacerations is accomplished during our Skills Camp using the beef tongue obstetric laceration model. This excellent experience is helpful in orienting our residents to these important repairs before they are called on to perform one on the obstetrical service!

Real-World OR Experience

Our resident physicians transition rapidly from simulation to the real-world operating environment. “Primary surgeon” experience is defined by the ACGME as when you perform greater than 50% of a given procedure. “Teaching assistant” experience is defined as when you are the senior resident assisting and teaching the primary surgeon. When other residency programs provide primary operator experience with many different attending physicians at different hospitals, it is possible that supervising attending surgeons don’t ever get to know you well enough to trust you to truly primary their cases. At Mizzou, most of our attending physicians are core faculty members and they get to know you well and learn to trust you early in your training. Moreover, you often operate with an upper-level resident as your teaching assistant. Your attending physician will be present in the OR for cesarean sections and hysterectomies, for example, but as you gain experience, they may not scrub in, but supervise from the side of the room. This is very valuable, especially as you become an upper-level resident, because it facilitates your progression in responsibility. Teaching a lower-level resident how to perform a surgery makes you think about that surgery in ways you never would have otherwise.

Per-graduate surgical case numbers at Mizzou are average (+/- 0.5 SD) compared to national reported means, with some notable exceptions. Our total hysterectomy numbers are at the mean, but we major in minimally invasive approaches: our vaginal hysterectomy numbers (75-80%ile) and total laparoscopic hysterectomy numbers (60%ile) are high and result in improved patient satisfaction and recovery time and fewer postoperative complications. Our residents all learn how to perform “difficult” vaginal hysterectomies and both “straight-stick” and “daVinci” techniques and graduates log 30-40 primary operator robot cases, allowing them to become “robot qualified” by the time of graduation. Our weakness is in abdominal hysterectomy, since > 90% of all hysterectomies performed in our program is through a minimally invasive approach.

Summary

We are committed to providing the very best educational experience for our residents. Our vision is to maximize the use of time to give our residents a "jump start" into the surgical arena. Once residents enter the OR environment, they rapidly achieve progressive levels of responsibility, eventually teaching lower-level residents how to perform many of the cases.

References

  • Eraut M. Knowledge creation and knowledge use in professional contexts. Studies in Higher Education 1985;10:117-133.
  • Barrier BF, McCullough MW. OB/GYN Program Director survey of use of procedure simulation. APGO/CREOG Combined Annual Meeting, March 2012, Orlando, FL.
  • Barrier BF. Simulation center: Is it useful? A survey of program directors and review of utilization. Oral Presentation, ACGME’s Annual Educational Conference, March 3-6, 2011, Nashville, Tennessee.
  • Barrier BF, Drobnis E, Espinoza L, McCullough MW. Influence of Laparoscopic Simulation Practice on Cognitive Visual-Spatial Testing; APGO/ CREOG Combined Annual Meeting, March 2010, Orlando, Florida.
  • Thompson A, McCullough MW, Barrier BF. Vaginal Hysterectomy Surgical Model. APGO/ CREOG Combined Annual Meeting, March 5-9, Orlando, FL, 2008.