# Evaluating Fundamentals of Vaginal Surgery for Use Among Obstetrics and Gynecology Residents in Accra, Ghana

## TL;DR

This study evaluates the experience and confidence of Ob/Gyn residents in Ghana with vaginal surgery using a simulator and introduces a region-specific proficiency score for training.

## Contribution

The study provides validity evidence and a region-specific proficiency score for vaginal surgery training in Ghana.

## Key findings

- Only 9.1% of residents had performed a vaginal hysterectomy in the past year.
- Experienced participants scored significantly higher on the FVS skills assessment than novices.
- Only 28.6% of experienced participants achieved the proficiency score of ≥266.

## Abstract

We aimed to assess obstetrics and gynecology (Ob/Gyn) resident experience and confidence with vaginal surgery and ability to perform basic vaginal surgery skills using a vaginal surgery simulator at a teaching hospital in Ghana. We present validity evidence and a region-specific proficiency score that can be used for training.

In this cross-sectional study at a teaching hospital in Accra, Ghana, Ob/Gyn residents in a 3-year training program completed a survey on demographics, vaginal surgery exposure, and surgical confidence. Using the Fundamentals of Vaginal Surgery (FVS) simulation system, participants performed five timed tasks twice each. A region-specific proficiency score of ≥ 266 was used to assess skill proficiency.

Thirty-four participants were enrolled. Of the 22 who provided details about types of vaginal surgery they had performed, only two (9.1%) had completed a vaginal hysterectomy in the past 12 months. All participants described being “not at all confident” in performing vaginal hysterectomy and other vaginal surgeries and “somewhat or slightly confident” in their surgical skills. The median (IQR) overall normalized score for the FVS hands-on skills assessment was 57.5 (6.3, 113.8) for novice and 160.0 (95.8, 312.0) for experienced participants (P = 0.005). Five percent of novice and 28.6% of experienced participants achieved the proficiency score of ≥ 266.

We present validity evidence and a region-specific proficiency score supporting the use of FVS in a Ghanaian training program. Limited experience in vaginal surgery, low confidence and performance scores highlight an opportunity to utilize this training system.