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Medical education research in obstetrics and gynecology

Published:September 18, 2018DOI:https://doi.org/10.1016/j.ajog.2018.09.013
      To the Editors:
      The recently published article “Implementation and Validation of a Retroperitoneal Dissection Curriculum”
      • Yousuf A.A.
      • Frecker H.
      • Satkunaratnam A.
      • Shore E.M.
      Implementation and validation of a retroperitoneal dissection curriculum.
      describes the design and evaluation of a surgical curriculum in gynecology. The authors should be congratulated on an innovative method for teaching a difficult subject aiming to improve patient care. From a scientific point of view, however, there are several concerns about the publication of this type of research.
      First, there is no generalizable concept that is being tested or explored and no underlying theoretical framework is used to explain what constituted the active ingredients that caused the observed effects. This makes replication highly difficult and limits the application of study results in other contexts significantly. In other words, evaluation of courses and curricula may be useful and of local interest but they rarely add anything to our existing knowledge base.
      • Bordage G.
      Conceptual frameworks to illuminate and magnify.
      • Norman G.
      Data dredging, salami-slicing, and other successful strategies to ensure rejection: twelve tips on how to not get your paper published.
      Second, as a scientific community we need to carefully evaluate study methods regardless of the topic being explored. The present study, for example, used a pretest posttest design to conclude that participants learned something when being taught. While the obvious nature of this conclusion may seem intuitive, it begs the question: is there any type of teaching and training that would fail to improve trainees’ knowledge and skills over time? And does this design allow us to make causal inferences?
      • Shadish W.R.
      • Cook T.D.
      • Campbell D.T.
      Experimental and quasi-experimental designs for generalized causal inference.
      We should ask ourselves if we would accept the same conclusions in clinical research using the same study design and outcome measures as those used in the present study (and in many other education studies published in clinical journals). For example, would we accept a study that concluded that a new operative method results in improved outcomes based on differences before and after the intervention? Probably not, just as we should not accept the use of self-assessments, which repeatedly have proven to be poor indicators of actual skills or knowledge.
      • Eva K.W.
      • Regehr G.
      • Gruppen L.D.
      Blinded by “insight”: self-assessment and its role in performance improvement.
      In other words, if the journal and our community wish to take medical education research seriously, we need to apply the same standards as expected in clinical research to medical education research, while emphasizing the role of improving our conceptual understanding of a subject rather than concluding that training works or that trainees loved the course.

      References

        • Yousuf A.A.
        • Frecker H.
        • Satkunaratnam A.
        • Shore E.M.
        Implementation and validation of a retroperitoneal dissection curriculum.
        Am J Obstet Gynecol. 2018; 219: 395.e1-395.e11
        • Bordage G.
        Conceptual frameworks to illuminate and magnify.
        Med Educ. 2009; 43: 312-319
        • Norman G.
        Data dredging, salami-slicing, and other successful strategies to ensure rejection: twelve tips on how to not get your paper published.
        Adv Health Sci Educ Theory Pract. 2014; 19: 1-5
        • Shadish W.R.
        • Cook T.D.
        • Campbell D.T.
        Experimental and quasi-experimental designs for generalized causal inference.
        Houghton, Mifflin and Company, Boston (MA)2002
        • Eva K.W.
        • Regehr G.
        • Gruppen L.D.
        Blinded by “insight”: self-assessment and its role in performance improvement.
        in: Hodges B.D. Lingard L. The question of competence: reconsidering medical education in the twenty-first century. Cornell University Press, New York (NY)2012: 131-154

      Linked Article

      • Implementation and validation of a retroperitoneal dissection curriculum
        American Journal of Obstetrics & GynecologyVol. 219Issue 4
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          Competency-based education requires educators to use simulation training for the purposes of education and assessment of resident trainees. Research demonstrates that improvement in surgical skills acquired in a simulated environment is transferrable to the operative environment. Laparoscopic retroperitoneal dissection, opening the retroperitoneal space and identifying the ureter, is a fundamental skill for gynecologists. Integrating simulation models into a formal and comprehensive curriculum for teaching ureterolysis could translate to increased surgical competency.
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        American Journal of Obstetrics & GynecologyVol. 220Issue 1
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          We thank Dr Tolsgaard for his thoughtful letter regarding our article “Implementation and Validation of a Retroperitoneal Dissection Curriculum.”1 Although residency programs understand the need for simulation-based training, there are limited evidence-based curricula available, particularly in gynecology. Our study presented a comprehensive, multimodal teaching approach to laparoscopic retroperitoneal dissection.
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