Electrosurgical loop excision of the cervical transformation zone: preclinical training proficiency

The purpose of this investigation was to evaluate learning errors and preclinical psychomotor skill acquisition among physicians learning the electrosurgical loop excision of the cervical transformation zone (ELECTZ) procedure.

Gynecologists attending one-day ELECTZ continuing medical education courses demonstrated their newly acquired ELECTZ cognitive and procedural skills. A bovine cervical model was used to simulate the uterine cervix and cervical pathology. Subjects performed successive procedures until an adequate specimen was obtained.

The mean number of procedural attempts to achieve proficiency was 1.61; 38 of 51 (75%) subjects were proficient following three trials. Thirty-nine percent (20 of 51) of subjects were successful following the first attempt, and an additional 14 of 23 were successful after the second trial. The most common (27%) defective specimen shape resulted from rapid terminal excision and subsequent shallow skewed tissue. Temporary loop electrode or tissue impedance was experienced by 35% of subjects during the first procedure.

The ELECTZ procedure is mastered by most physicians with few complications following a minimal number of attempts. The most common procedural errors resulted from excessively rapid surgical technique. Realistic management scenarios with simulated model practice should be used when teaching the ELECTZ procedure to physicians.