Canadian hysterectomy educational experience: survey of recent graduates in obstetrics and gynecology

Abstract

Study objectives: To determine the hysterectomy surgical training acquired by 289 recent (2005-2010) Canadian graduates in obstetrics and gynecology, their comfort level in performing various types of hysterectomy, and their practice plans.

Design: Electronically distributed national survey (Canadian Task Force classification III).

Measurements and main results: The response rate was 37% (107 respondents). In the laparoscopic hysterectomy categories, during residency, 56% performed 5 laparoscopic subtotal hysterectomies (LSTHs) or fewer, 69.1% performed 5 total laparoscopic hysterectomies (TLHs) or fewer, and 43.9% performed 5 laparoscopic-assisted vaginal hysterectomies (LAVHs) or fewer. In contrast, 64.5% performed at least 50 abdominal hysterectomies, and 57.1% performed at least 21 vaginal hysterectomies. Although most respondents reported they were comfortable performing abdominal hysterectomy (99%) and vaginal hysterectomy (87%), fewer were comfortable performing LAVH (63.4%), LSTH (42%), and TLH (26%). Only 40.2%, 60.9%, and 69.7%, respectively, plan to perform LSTH, TLH, and LAVH in their practices. There was a trend toward increasing comfort level with laparoscopic hysterectomy as the years since graduation increased, but no difference in practice plans. Most respondents gain further surgical proficiency through fellowship training and colleague preceptorship.

Conclusions: Although laparoscopic hysterectomy has substantial benefits compared with laparotomy, Canadian residents in obstetrics and gynecology are not receiving adequate training to feel comfortable using the laparoscopic approach as opposed to the vaginal and abdominal routes. To improve patient care, further educational initiatives are needed to ensure that graduates are capable of performing all types of hysterectomy.