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Published:September 18, 2018DOI:https://doi.org/10.1016/j.ajog.2018.09.014
      We thank Dr Tolsgaard for his thoughtful letter regarding our 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.
      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.
      Dr Tolsgaard raised a concern regarding the lack of a theoretical framework guiding our research. Although not explicitly stated, we followed the framework of Zevin et al
      • Zevin B.
      • Levy J.S.
      • Satava R.M.
      • Grantcharov T.P.
      A consensus-based framework for design, validation, and implementation of simulation-based training curricula in surgery.
      for curriculum design and validation, including both cognitive and technical skills components. This framework draws on the theory of cognitive integration, explaining how transfer is improved when training incorporates both conceptual and procedural knowledge.
      • Cheung J.H.
      • Kulasegaram K.M.
      • Woods N.N.
      • Moulton C.A.
      • Ringsted C.V.
      • Brydges R.
      Knowing how and knowing why: testing the effect of instruction designed for cognitive integration on procedural skills transfer.
      Our curriculum began with a video-based lecture regarding Why (conceptual) task elements and technical model practice for How (procedural) task elements.
      To Dr Tolsgaard’s second point about the assumption that teaching in any form leads to improvement in knowledge and skills, we contend this has yet to be proven in surgical training. If Dr Tolsgaard truly believes this assumption, then what is the value of education research as a field? We argue that an important step in any study design is ensuring the validity of our assumptions. In our case, we tested the assumption that simulation improves knowledge and procedural skill and that those improvements correlate with improved real-world performance. This assumption is crucial in the context of simulation-based training and evaluation in the era of competency-based training.
      • Wohlrab K.
      • Jelovsek J.E.
      • Myers D.
      Incorporating simulation into gynecologic surgical training.
      We agree with Dr Tolsgaard’s final point about study design in educational research. Like pregnant patients, trainees are a vulnerable study population. We recognize the value of randomized double-blinded placebo-controlled trials; however, feasibility prevents this approach with medical trainees. We agree that self-assessment and learner satisfaction should not be primary outcomes of education research, and thus we designed our study with a primary outcome of the validated measurement of surgical skills transfer. As educators, we have to be cognizant of the effects of training and assessment on trainee wellness and engagement, so we believe that trainee satisfaction is a necessary component of programmatic assessment.
      Finally, a genuine problem in health professions education research is the ability to reach the clinical audience involved in day-to-day trainee teaching. Most clinicians are unfamiliar with the concept of theoretical frameworks. As the American Journal of Obstetrics and Gynecology is a clinical journal, we deliberately left out the use of medical education jargon to make our article more accessible to those on the front lines.

      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
        • Zevin B.
        • Levy J.S.
        • Satava R.M.
        • Grantcharov T.P.
        A consensus-based framework for design, validation, and implementation of simulation-based training curricula in surgery.
        J Am Coll Surg. 2012; 215: 580-586
        • Cheung J.H.
        • Kulasegaram K.M.
        • Woods N.N.
        • Moulton C.A.
        • Ringsted C.V.
        • Brydges R.
        Knowing how and knowing why: testing the effect of instruction designed for cognitive integration on procedural skills transfer.
        Adv Health Sci Educ Theory Practice. 2018; 23: 61-74
        • Wohlrab K.
        • Jelovsek J.E.
        • Myers D.
        Incorporating simulation into gynecologic surgical training.
        Am J Obstet Gynecol. 2017; 217: 522-526

      Linked Article

      • Medical education research in obstetrics and gynecology
        American Journal of Obstetrics & GynecologyVol. 220Issue 1
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          The recently published article “Implementation and Validation of a Retroperitoneal Dissection Curriculum”1 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.
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