E. Matthew Ritter, MD1, Matthew Lineberry, PhD2, Daniel A Hashimoto, MD, MS3, Denise Gee, MD3, Angela A Guzzetta, MD4, Walter B Kucera, MD1, Matthew D Nealeigh, DO1, Daniel J Scott, MD4. 1Uniformed Services University/Walter Reed National Military Medical Center, 2University of Kansas Medical Center, 3Massachusetts General Hospital, 4University of Texas Southwestern
Background: Psychometric analysis of the Fundamentals of Endoscopic Surgery (FES) performance exam showed discernibly higher scores for males than females. Psychological research has explored gender differences in visuospatial performance, finding that differences, when present, can be reduced with task-specific practice. We sought to assess the effect of simulation-based mastery learning (SBML) curricula on FES performance exam differences by gender.
Methods: Forty-four surgical trainees (25 men (m), 19 women (w)) from three institutions were assessed for baseline endoscopic skill with the FES performance exam. Forty-seven (29 m, 18 w) then completed a SBML curriculum and were assessed by FES. Fourteen trained on the GI Mentor 2 (GIM), 18 on the Endoscopy Training System (ETS), and 15 using the simulators described in the Surgical Training for Endoscopic Proficiency (STEP) curriculum. For the ETS and STEP groups the same group of subjects performed pre- and post-training assessments. For the GIM group, the pre-training group represented a historical control. Performance of male and female trainees was compared.
Results: On the pre-training assessment, there were large differences between genders in FES pass rates (m 77%, w 15%, p<0.001) and total scores (m 69 +/-11, w 50 +/-12; p< 0.001). Differences were also present in four of the five FES sub-task scores (Navigation, m 73 +/- 19, w 55 +/- 22, p= 0.02; Loop reduction, m 34 +/- 29, w 14 +/- 22, p= 0.02; Retroflexion, m 81 +/- 17, w 47 +/-27, p< 0.001; Targeting, m 89 +/- 10, w 66 +/- 23, p= 0.002) despite similar median PGY levels and endoscopic experience. No such differences were discernible post-training (Pass rate, m 100%, w 94%, p= 0.4; Total score, m 77 +/- 8, w 72 +/- 12, p= 0.2; Navigation, m 91 +/- 13, w 80 +/- 13, p= 0.009; Loop reduction, m 49 +/- 26, w 46 +/- 36, p= 0.7; Retroflexion, m 82 +/- 18, w 81 +/- 15, p= 0.9; Targeting, m 92 +/- 15, w 86 +/- 12, p= 0.12). Time needed to complete curricula was also not discernably different by gender (m 3.8 +/- 1.7 hours, w 5.0 +/- 2.6 hours, p= 0.17).
Conclusions: Gender-based differences on the FES performance exam are nearly eliminated through task-specific SBML training, consistent with previous findings in psychology about such visuospatial differences. These findings lend further evidence to the validity argument for the FES performance exam as a measure of basic endoscopic skills.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88413
Program Number: S086
Presentation Session: MIS Education Session
Presentation Type: Podium
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