CME Needs Assessment

Relevant effective practice-based continuing education

By developing educational courses in minimally invasive gynecology (MIG) we hope to increase the use of MIG and reduce morbidity and complication rates associated with these procedures.

Practice Gap
At present in the United States, about 15 to 20% of the 600,000 hysterectomies are performed by laparoscopy and robotics, respectively. This is due to lack of training during their formal education and the multiple difficulties to acquire formal training once in medical practice.

Gap Analysis
MIG procedures are aimed at preserving the highest possible quality of life for women by using smaller and fewer incisions, reducing pain and trauma to the body, and enabling quicker recovery. Yet, the ability to perform these more patient-friendly procedures requires most gynecologists to commit to post-residency training since they are not routinely taught during formal training. This requires a commitment to lifelong learning to attain specialized skills in pelvic surgery and because of the development of new technologies and instrumentation.  Since training varies and is often performed in a manner that is not standardized and subject to bias, it is vital that gynecologists achieve procedural mastery through good surgical coaching and feedback.

Planning the Intervention

The goal of our intervention is that through continuing medical education (CME) organized into didactic and hands-on sessions gynecologists will acquire and/or advance their skills in MIG. An open forum will follow with discussion designed to stimulate interaction between faculty and learners.

Proposed Method

  1. Create awareness of the role MIG plays and review the current literature relative to MIGS
  2. Host hands-on labs that will allow each participant to practice MIG techniques on cadavers
  3. Offer surgeons with minimally invasive experience the opportunity to refine their skills and technique in both robotic assisted and traditional laparoscopic surgery
  4. Review of the fundamentals of laparoscopic suturing, from basic to advanced
  5. Transfer skill to course participants through didactic lectures, video presentations, demonstrations, and supervised wet lab surgeries
  6. Expectations are that future courses will be organized to spread awareness and transfer skills in MIG to other gynecologists, who are willing to commit to this lifelong process
  7. To maximize the return of this year’s Congress, upon completion participants will be requested to explain how their newly acquired knowledge and skills will impact their practice

Objectives
At the conclusion of the course, participants should be able to:

  1. Apply the latest developments in minimally invasive healthcare for women
  2. Demonstrate the skills needed for proficiency
  3. Employ minimally invasive surgical techniques such as laparoscopic hysterectomy, myomectomy, pelvic floor repair, treatment of endometriosis and advanced hysteroscopic techniques
  4. Acquire hands-on experience in the anatomy laboratory as well as laboratories focused on laparoscopic suturing, hysteroscopy, robotic surgery, and single-port surgery
  5. Apply the latest advances in research and techniques in the field of minimally invasive gynecologic surgery
  6. Evaluate data presented to determine the best methods for practice of gynecologic medicine
  7. Demonstrate and enhance their presentation and publication skills with a hands-on workshop
  8. Explore the practice that exists in the intersections between surgical gynecology and other disciplines such as obstetrics, oncology, reproductive medicine, pediatrics, and adolescent medicine
  9. Identify complications which may occur during minimally invasive surgery in order to better prevent, avoid, and manage complications
  10. Provide culturally, ethnically, and sociologically inclusive clinical care

Additional Barriers and Possible Solutions
Barrier: MIG is relatively difficult to learn, and all procedures require accurate surgical skills and experience to perform. Therefore, the course participants may not be able to utilize the techniques immediately upon completion of this course.

Possible Solution: Continue to provide physicians with additional education and the resources they need to elevate their practice in gynecology while increasing their skills in minimally invasive gynecology.

Barrier: Literature states that “Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology exist and these differences are not fully accounted for by patient, socioeconomic, or healthcare infrastructure factors. Initiatives that incentivize hiring surgeons trained to perform complex gynecologic surgery, standardized pathways for route of surgery, quality improvement focused on increased hospital MIS volume, and hospital-based public reporting of MIS volume data may be of benefit for minimizing disparities.”(1) 

Possible Solution: “Initiatives to reduce disparities need to address racism, implicit bias, and healthcare structural issues that perpetuate disparities.”(1) AAGL continues to include content to address cultural considerations in care, disparities in care, and implicit bias when planning accredited education with the hope that learners develop and implement strategies to address unintended biases in decision making and health care disparities.

(1) Barnes WA, Carter-Brooks CM, Wu CZ, Acosta DA, Vargas MV. Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology. Curr Opin Obstet Gynecol. 2021 Aug 1;33(4):279-287. doi: 10.1097/GCO.0000000000000719. PMID: 34016820.

Code of Conduct
AAGL is committed to providing a friendly, safe, supportive, and harassment-free environment during the Congress. AAGL expects Congress participants to respect the rights of others and communicate professionally and constructively, whether in person or virtually, handling disagreement with courtesy, dignity, and an open mind. All participants are expected to observe these rules of conduct in all Congress venues. Organizers will actively enforce this code throughout this event. Violations are taken seriously. If an attendee or participant engages in inappropriate, harassing, abusive or disruptive behavior or language, the AAGL has the right to carry out any action it deems appropriate.

What to Do
If you have any concerns about an individual’s conduct, please go to the AAGL Registration Counter for the procedure to follow to report the incident.

Age Restriction
Children under 16 years of age are not permitted in sessions and workshops, but may be allowed into the exhibit hall if accompanied by an adult.

Audio-Visual Recording
Video- and audio-recording of sessions by congress attendees is strictly prohibited. Registration, attendance, or participation in AAGL meetings, Congress, and other activities constitutes an agreement that allows AAGL to use and distribute your image or voice in all media. If you have questions about this policy, please visit the AAGL Registration Counter.

Anti-Harassment Statement
AAGL encourages its members to interact with each other for the purposes of professional development and scholarly interchange so that all members may learn, network, and enjoy the company of colleagues in a professional atmosphere. Consequently, it is the policy of the AAGL to provide an environment free from all forms of discrimination, harassment, and retaliation to its members and guests at all regional educational meetings or courses, the annual global congress (i.e. annual meeting), and AAGL-hosted social events (AAGL sponsored activities). Every individual associated with the AAGL has a duty to maintain this environment free of harassment and intimidation.

Reporting an Incident
AAGL encourages reporting all perceived incidents of harassment, discrimination, or retaliation. Any individual covered by this policy who believes that he or she has been subjected to such an inappropriate incident has two (2) options for reporting:

1. By toll free phone to AAGL’s confidential 3rd party hotline: (833) 995-AAGL (2245) during the AAGL Annual or Regional Meetings.

2. By email or phone to: The Executive Director, Linda Michels, at lmichels@aagl.org or
(714) 503-6200.

All persons who witness potential harassment, discrimination, or other harmful behavior during AAGL sponsored activities are expected to report the incident and be proactive in helping to mitigate or avoid that harm and to alert appropriate authorities if someone is in imminent physical danger.

For more information or to view the policy please visit https://www.aagl.org/wp-content/uploads/2018/02/AAGL-Anti-Harassment-Policy.pdf