A Pragmatic Review of Colposcopy and LLETZ (Large Loop Excision of the Transformation Zone) Simulation Models

Due to limited training opportunities and recent emphasis on patient safety and ethical concerns with the traditional surgical training practice of see one, do one, simulation training has been widely implemented for surgical procedures such as hysteroscopy and laparoscopy. Despite being commonly performed gynecologic procedures, simulation for colposcopy and Large Loop Excision of the Transformation Zone (LLETZ) or Loop electrosurgical excision procedure (LEEP) have not been thoroughly studied and reported. This review aims to summarize the currently available simulation models for colposcopy and LLETZ/LEEP and their effectiveness as a surgical training tool in the last 20 years.

Searches were performed on the following databases: PubMed, EmBase, PsychINFO, and Cochrane Library.

The pragmatic review included 13 studies from 2012 to 2023. An average of 74 participants were included in each study, with experiences ranging from medical students, nurses, and midwives to consultant gynecologists. The mode of delivery for simulated training was similar in most studies, while the methods of assessment varied widely. After simulation training for both colposcopy and LLETZ/LEEP, satisfaction and increased confidence were reported, as well as improved knowledge and performance scores. Only one study (7.7%) reported on the application of practice to real-life clinical practice after simulation training.

There is promising evidence to support the implementation of simulation models in gynecology training for colposcopy and LLETZ/LEEP procedures, particularly in skills and knowledge improvement. Barriers arising from gender-based health inequity may play a role in the lack of research into simulation training in colposcopy and LLETZ/LEEP.