Correspondence:
Pr Pierre-Emmanuel Bouet, MD, PhD.
Department of Reproductive Medicine,
Angers University Hospital,
4 rue Larrey, 49000 Angers, France.
E-mail: pierreemmanuel.bouet@chu-angers.fr
Tel: +33 7 84 19 80 21
In the field of Reproductive Endocrinology and Infertility, oocyte
retrieval (OR) constitutes the main invasive procedure that is taught to
residents and fellows in training.
Indeed, as the number of oocytes retrieved increases, so does the
cumulative live birth rate.1 Given the importance of
the procedure, it is important that residents and fellows be well
prepared when performing their first procedures on patients. Recently, a
high-fidelity system for the simulation of OR was developed.
Based on that, we aimed to assess the impact of an ORSTP on the clinical
performance of Ob/Gyn residents.
We performed a prospective study, between May 2018 to November 2021, at
the Angers University Hospital. All patients signed an informed consent
prior to inclusion.
We included all OR performed by Ob/Gyn residents during the study
period. The Simulation (S) group included oocyte retrieval (OR)
performed by residents who had undergone an ORSTP before performing them
on patients (n=422) and the control (C) group included OR performed by
residents who had not received prior simulation training (n= 329). The
OR simulation training program was performed on
PickUpSimTM.
Residents in the S group spent the first 15 days of rotation observing
the OR performed by the physicians, and in the afternoon participated in
simulation training sessions. In the following 15 days, the residents
started performing the OR under direct supervision from senior
physicians. Residents punctured one side and the senior physician the
other side. In the C group, residents did not participate in any
simulation sessions. Following the observation period of 15 days, they
started and completed their training exactly as residents in the S
group. After the end of the first month, residents started performing
the entirety of the OR. At the end of the first month of their rotation,
residents in both groups filled a satisfaction survey concerning their
respective training.
Our main outcome measure was the OR rate (ORR) (number of oocytes
collected/number of follicles aspirated) during the first 3 months of
the rotation.
The acceptable ORR for senior physicians is at least 70% when including
all mature follicles,2-3 while studies have shown that
a resident without much REI experience has a significantly lower ORR
than that of a senior physician.4 Based on that, and
knowing that the policy at our center is to aspirate all follicles ≥ 8
mm, we considered an ORR ≥ 55% as acceptable for residents. On the
other hand, we believe that the ORSTP could improve the ORR by 5% and
that the improvement should be observable one month after training.
Therefore, we included 834 OR, 417 in each group, in order to have a
90% power and an α risk of error of 5%.
In the S group, 6 residents aspirated 657 ovaries while in the C group,
5 residents aspirated 508 ovaries. The characteristics of patients andIn Vitro Fertilization cycles were comparable between S and C
groups.
The mean ORR during the first 3 months of rotation were comparable
between the S and C groups (59% vs 58%). ORR during the first and
second month, and at the end of the rotation were also comparable
between the S and C groups (54% vs 63%, 58% vs 59% and 58% vs 58%,
respectively) (Figure 1). There was no significant difference in the
rate of failed OR (3.3% vs 1.8%) between the S and C groups. Finally,
16% of residents in the S group reported being stressed before their
first OR compared to 40% in the C group.
The ORSTP does not improve the residents’ clinical performance, but it
could decrease their stress in clinical practice.