Validity evidence for the Essentials in Minimally Invasive Gynecologic Surgery laparoscopic skills: correlation with...

The Essentials in Minimally Invasive Gynecologic Surgery manual skills examination is a new qualifying examination for board certification in obstetrics and gynecology. The aim of this study is to examine the validity evidence for the use of Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation by assessing performance of laparoscopic tasks (sleeve transfer, circle cut, extracorporeal knot tying, intracorporeal knot tying, and running stitch) using a previously studied global rating scale for laparoscopic surgery (Global Operative Assessment of Laparoscopic Skills).

Expert laparoscopic educators evaluated video recordings of participants performing laparoscopic exercises from the Essentials in Minimally Invasive Gynecologic Surgery construct validation trial using the modified Global Operative Assessment of Laparoscopic Skills (depth perception, bimanual dexterity, efficiency, and tissue handling), scoring them on a 5-point anchored Likert scale with higher scores indicating better performance. Spearman's correlation tests were used to assess correlations among scores, and Wilcoxon rank-sum tests were used to compare groups. Weight kappa statistics were calculated to assess inter-rater agreement. All statistical analyses were conducted on R 4.3.1.

We included 144 participants: 54 postgraduate year 1 residents, 55 postgraduate year 3 residents, 20 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings, and 15 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings who completed a Minimally Invasive Gynecologic Surgery fellowship. We demonstrated that more proficient participants achieved higher Global Operative Assessment of Laparoscopic Skills scores. There were weak to moderate negative correlations between Global Operative Assessment of Laparoscopic Skills scores and time to task completion as well as total number of errors for each exercise (r=0.55-0.70, P<.001; r=0.28-0.55, P=.003 to P<.001, respectively). Participants who passed Essentials in Minimally Invasive Gynecologic Surgery scored better on Global Operative Assessment of Laparoscopic Skills (passed: median individual item Global Operative Assessment of Laparoscopic Skills scores (interquartile range) 3 to 3.5 [2, 4] vs failed: 1 to 2 [1, 3], P<.001-.08).

More experienced participants and participants who passed Essentials in Minimally Invasive Gynecologic Surgery perform laparoscopic Essentials in Minimally Invasive Gynecologic Surgery exercises with better skills. Importantly, those who passed Essentials in Minimally Invasive Gynecologic Surgery performed at a corresponding Global Operative Assessment of Laparoscopic Skills score of at least 3 (range, 1-5) for all the items (depth perception, bimanual dexterity, efficiency, and tissue handling). Given that Global Operative Assessment of Laparoscopic Skills are easy to use and widely available, while Essentials in Minimally Invasive Gynecologic Surgery metrics are proprietary and cannot be accessed, Global Operative Assessment of Laparoscopic Skills can be used as a proxy for the Essentials in Minimally Invasive Gynecologic Surgery passing score during preparation. In addition, our study adds to the body of validity evidence, further supporting Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation for obstetrics and gynecology trainees.