Trending Issues in Training: Endoscopy

By Dr. Stephen Grochmal, Associate Clinical Professor of Obstetrics and Gynecology, Division of Minimally Invasive Surgery at Howard University College of Medicine in Washington, D.C.

Current training in basic and advanced hysteroscopy within the 244 Gyn residency programs nationwide has been woefully insufficient relative to the skills necessary to perform both diagnostic and operative hysteroscopic procedures on a routine basis in any healthcare setting. Many of these acquired skills, along with a thorough knowledge of managing a conscious patient using local anesthetic techniques, could easily be applied to office-based hysteroscopy. The benefits of this are impactful for both patient and doctor. Despite the lack of superior training, the MIS Fellowship Programs (AAGL society) provide excellent training experience but only award certification to approximately 30 physicians per year; a very small percentage relative to all graduating OB/GYN residents. We need much more quality training to be available.

HERE IS a summary of A RECENT survey highlighting this issue:

o Fellowship directors do not believe graduating residents are well-prepared for training in the four accredited obstetrics/gynecology subspecialties, a survey has shown.

o The researchers contacted program directors from 218 American Board of Obstetrics and Gynecology–accredited fellowship programs in pelvic medicine and reconstructive surgery, gynecologic oncology, maternal–fetal medicine, and reproductive endocrinology–infertility between June 1, 2014, and August 31, 2014.

o At the surgical procedure level, 20% of first-year fellows were rated as able to independently perform a vaginal hysterectomy, 46% an abdominal hysterectomy, and 34% basic hysteroscopic procedures. "Half of incoming clinical fellows (51%) were rated as unable to independently set up a retractor and pack the bowel for pelvic surgery," the authors report.

Given the issues highlighted in the survey, relevant with academic institutions, manufacturers and distributors of surgical devices developed for hysteroscopic procedures must be prepared to support a comprehensive training initiative to ensure appropriate product adoption including instruction on safe and effective utilization of their equipment. EndoVentions Medical has taken the initiative and is developing a comprehensive training program that incorporates the following:

o  Trainees will benefit by reviewing current clinical studies and other pertinent printed reference materials. This training manual, covering the use of proper hysteroscopic  techniques, including guidelines, and product specific presentations augmented with interactive video.

o  EndoVentions will offer hysteroscopy courses at major societal meetings

o  EndoVentions is preparing to utilize experienced hysteroscopic surgeons, acting as mentors.

o   Development of a Hysteroscopy Teaching Module, (ACOG certified) will be offered to residency/Fellowship programs.

o  EndoVentions is also developing an internal-based, highly qualified tech support department to address urgent issues regarding products or tech support, along with a section providing answers to standard questions, a “how to” on hysteroscopy procedure questions.

In conjunction with skilled hysteroscopic surgeons, EndoVentions believes it can help pave the way to offering novel training opportunities to support current residency and fellowship programs. After all, helping to improve the surgical skills of upcoming hysteroscopic surgeons is tantamount to successful patient outcomes, which is a satisfying surgical experience. It is time that we all work together to advance hysteroscopy and  hysteroscopic surgery into the next paradigm.

Stephen Grochmal, MD is an internationally recognized minimally invasive gynecologic surgeon, medical inventor and enthusiast for cutting edge endoscopic surgical procedures and treatments in gynecology.

Dr Grochmal has been an invited guest speaker for two past Presidents of the United States at the White House in Washington, DC.

Presently, Dr Grochmal is an Associate Clinical Professor of Obstetrics and Gynecology (Adjunct Faculty) in the Division of Minimally Invasive Surgery at Howard University College of Medicine in Washington, D.C. Dr Grochmal is also an appointed faculty member of the National Procedures Institute, the CME provider for the American Academy of Family Physicians. In 2018, Dr Grochmal was named Top Doc in Montclair, N.J. specializing in Office-Based Minimally Invasive Gynecologic Surgery.

Since 2000, Dr Grochmal has applied his 30 years of multiple laser wavelengths experience and pioneering minimally invasive surgical expertise to design and develop novel miniaturized and nanotechnology-based surgical devices for minimally invasive gynecologic applications. Dr. Grochmal maintains a robust sub-specialized practice focused on office-based/outpatient minimally invasive gynecologic surgery for gynecologic