DEVELOPMENT OF A CURRICULUM USING THE DELPHI METHOD SEUD 09/05/2015

Transcription

1 DEVELOPMENT OF A CURRICULUM USING THE DELPHI METHOD SEUD 09/05/2015! Dr Pierre PANEL! Marie-Emmanuelle NEVEU 26/10/15 1

2 SUMMARY Introuction! Hysteroscopy! Curriculum Methos! Delphi course! Choice of the questions! Choice of experts! Successive rouns Results! 1- Which notss oes a registrar nees to achieve?! 2- Which technical skills have to be controlle?! 3- Which surgical proceures have to be acquire?! 4- If a simulator training program existe, which items shoul be inclue?! 5- If a simulator program existe, which items woul you assess for the registrar's appraisal? Notss: non technical skills Conclusion 26/10/15 2

3 INTRODUCTION Hysteroscopy! Common proceure! Many inications! Have to be mastere by registrars! Drastic reuction of time spent in theatre > New ways of training nee to be evelope > Use of surgical simulators Curriculum! First step to buil a teaching program! Contains all require skillset an knowlege! Create by using Delphi metho 26/10/15 3

4 METHODS Delphi metho! Prospective process to buil consensus by questioning a panel of experts in an iterative way! Important steps > 1- Definition of questions > 2- Choice of experts > 3- Successive rouns 1) Questions! Meline search! Key wors : «teaching» an «hysteroscopy»! 48 references analyze, 37 selecte! 5 questions ientifie > 1- Which notss oes a registrar nee to master? > 2- Which technical skills have to be learne? > 3- Which surgical proceures to know? > 4- If a simulator training program existe, which items shoul be inclue? Consens us Meline search > 5- If a simulator training program existe, which criteria to assess practitioner s surgical skills? 26/10/15 4

5 METHODS 2) Choice of experts! 20 experts selecte! Criteria of choice > Gynecologists obstetricians > Simulation program applicant > Members of University or eucational committees > Publishe literature in Hysteroscopy > Involve in Hysteroscopy training Selection of experts! Auto-evaluation on 2 points > Level of expertise in hysteroscopy > Degree of involvement in stuent training 26/10/15 5

6 METHODS 3) Successive rouns! First roun (2 months) > 5 open-ene questions > To limit the number of answers uring the next roun Similar answers are gathere Irrelevant answers are remove > Item= answer after processing 1st Roun! Secon roun (1 month) > Feeback > Items rating with a 10 points Lickert scale > Consensus efine by : For 1 item : 80% of agreement (rates from 8 to 10) The aim is to establish a consensus on more than 60% of items! Repetition until consensus 2 n Roun Repetition until consensus 26/10/15 6

7 RESULTS Meline search! 48 references analyze, 37 selecte! 5 questions selecte 18/20 experts participate! 13 men, 5 women! Age average : 38 years! 13 worke in university hospitals! Auto-evaluation (average) on 5 # Level of expertise : 4,3 # Involvement in stuent training : 4,3 1st Roun! November 2014 to January 2015! 18 experts participate in the survey! 78 answers! 51 items create after processing ( gathering an removing) 2 n Roun! February to March 2015! 18 experts participate in the survey! 25/51 consensual items! Goal not reache 49% (<60%) 3r Roun! March 2015 to April 2015! 18 experts participate in the survey! 31/51 consensual items! Goal reache : 62% (>60%) 26/10/15 7

8 INCOMES Question 1 : Which notss oes a registrar nee to achieve?! 1 st roun > 14 answers > 7 items after processing! 2 n roun > 3 valiate items! 3 r roun > Consensus : 5 items / 7 (71%) Items Meian 2 n roun 3 r roun % agreement 8-10 Verification an knowlege of materials 10,00 89,00% Control of the surgical technique 8,00 83,00% Rigorous inication 8,50 89,00% Prior explorations : iagnostic hysteroscopy, pelvic echography Status Meian % agreement ,00 94,44% 8,50 88,89% 9,00 94,44% 8,00 78,00% - 8,00 88,89% Status Enometrium preparation 6,00 11,00% - 5,00 5,56% Delete Information about risks 9,00 72,00% - 9,00 83,33% Check 26/10/15 list 8,00 50,00% - 8,00 50,00% Delete 8

9 INCOMES Question 2 : Which technical skills have to be learne?! 1 st roun > 17 answers > 13 items after processing! 2 n roun > 6 valiate items! 3 r roun > Consensus : 8 items / 13 (62%) 2 n roun 3 r roun Items % agreement % agreement Meian Status Meian Status Management of bipolar an monopolar valiate 8,50 77,78% - 9,50 83,33% energies Pressure management 9,00 88,89% 9,00 88,89% Verification of the balance sheet input-output 10,00 88,89% 10,00 88,89% Complications management 9,00 88,89% 9,00 88,89% No violent movement 10,00 77,78% - 10,00 88,89% Careful cervical ilatation 10,00 94,44% 10,00 100,00% Correct hysteroscope fixing 10,00 94,44% 10,00 100,00% 26/10/15 9

10 INCOMES Question 3 : Which surgical proceures have to be acquire?! 1 st roun > 13 answers > No nee to processing! 2 n roun > 5 valiate items! 3 r roun > Consensus : 6 items / 13 (46%) 2 n roun 3 r roun Items % agreement % agreement Meian Status Meian Status Polypectomy 10,00 100,00% 10,00 100,00% Myomectomy 10,00 88,89% 9,00 88,89% Enometrial ablation 10,00 83,33% 9,50 94,44% Essure proceure 8,00 72,22% - 8,00 72,22% Delete Vaginoscopy 8,00 55,56% - 7,00 44,44% Delete Synechia 8,00 61,11% - 8,00 55,56% Delete Septum 8,00 55,56% - 7,00 44,44% Delete Enometrial ablation with new techniques 7,50 50,00% - 7,00 44,44% Delete Retaine trophoblastic tissue 9,50 77,78% - 9,00 83,33% 26/10/15 10

11 INCOMES Question 4 : If a simulator training program existe, which items shoul be inclue?! 1 st roun > 14 answers > 7 items after processing! 2 n roun > 4 valiate items! 3 r roun > Consensus : 5 items / 7 (71%) 2 n roun 3 r roun Items % agreement % agreement Meian Status Meian Status Ability of technical proceures 10,00 100,00% 10,00 100,00% Flui Management 9,00 83,33% 9,00 88,89% Ability of complications ( perforation, 9,00 83,33% 9,00 88,89% bleeing,pain,trauma) White balance 5,00 33,33% - 5,00 11,11% Delete Recognition of pathologies 9,00 88,89% 9,00 94,44% Haptic feeback 9,00 77,78% - 9,00 77,78% Delete Complete 26/10/15 iagnostic tour performe 9,50 77,78% - 9,00 83,33% 11

12 INCOMES Question 5 : If a simulator program existe, which criteria to assess practicionners surgical skills?! 1 st roun > 18 answers > 11 items after processing! 2 n roun > 7 valiate items! 3 r roun > Consensus : 7 items / 11 (64%) 2 n roun 3 r roun Items % agreement % agreement Meian Status Meian Status Absence of complication 9,00 88,89% 8,50 88,89% 3D orientation 9,00 100,00% 9,00 100,00% Percentage of resecte pathology 8,50 88,89% 9,00 88,89% Operating time 7,50 50,00% - 8,00 55,56% Delete Flui control 8,50 66,67% - 8,50 72,22% Delete Successful completion of proceure 8,50 94,44% 8,50 94,44% To know when to stop 9,50 100,00% 9,50 100,00% 26/10/15 12

13 INCOMES 1 st french consensus! A consensus was obtaine for 31 of the 51 items (62%) Question 1 : Which notss oes a registrar nee to master? Verification an knowlege of materials Control of the surgical technique Rigorous inication Question 2 : Which technical skills have to be learnt? Management of bipolar an monopolar energies Pressure management Verification of the balance sheet input-output Complications management Question 3 : Which surgical proceures to know? Polypectomy Myomectomy Enometrial ablation Prior explorations : iagnostic hysteroscopy, pelvic echography Information about risks No violent movement Careful cervical ilatation Correct hysteroscope fixing Knowlege of the inications of hysteroscopy Retaine trophoblastic tissue IUD removal Laparoscopy in case of perforation 5 items 8 valiate items 6 valiate items Question 4 : If a simulator training program existe, which items shoul be inclue? Ability of technical proceures Flui Management Ability of complications ( perforation, bleeing,pain,trauma) Recognition of pathologies Complete iagnostic tour performe 5 valiate items Question 5 : If a simulator program existe, Which criteria to assess practitioner surgical skills? Absence of complication 3D orientation Percentage of resecte pathology Successful completion of the proceure To know when to stop Goo visibility Knowlege of pathologies 7 valiate items 26/10/15 13

14 CONCLUSION Conclusion! Creation of the first French curriculum in hysteroscopy! Items selecte > Are in conformity with common practices an with curricula of RCOG an ESGE > Constitute precise, reproucible an easily appraisable elements! The next step is to buil a teaching program on simulator Horizons! The best simulator is the virtual reality one! Hystsim evelope by Virtame > Ability to measure the metrics we nee > Possibility of training in ifferent proceures! Definition of a reference score by experts on simulator! Ability to buil a teaching program for resients 26/10/15 14

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16 EXPERTS Experts N=18 Gener Female 5 Male 13 Age (min-max) 38 (32-59) Average (min-max) Place of pratice Universitaryhospital 13 Private structures 5 Position, n Cca et assistants 8 Praticien hospitalier 6 Puph 4 City, n (%) Angers 1 Bourg en Bresse 1 Marseille 1 Paris 7 Région parisienne 8 Auto-evaluation (average) on 5 Level of expertise 4,3 Involvement in stuent training (average) 4,3 26/10/15 16

17 TABLEAU 1) Which notss oes a registrar nees to achieve? Answers N Gathering Verification of fluis 14 Knowlege of the materials 10 Verification an knowlege of materials Control of the surgical technique 11 Control of the surgical technique Rigorous inication 9 Knowlege of pathologies 5 Rigorous inication Preoperative iagnostic hysteroscopy 6 Preoperative echography 1 Prior explorations : iagnostic Evaluation of the security wall 2 hysteroscopy, pelvic echography Preoperative enometrium biopsy 1 Enometrium preparation 3 Enometrium preparation Prevention of the injuries 7 Patient's information 1 Information about risks Check list 3 Check list Theorical course 1 Theorical course 26/10/15 17

18 TABLEAU 2) Which technical skills have to be controlle? Answers N Gathering Management of bipolar an monopolar Management of bipolar an monopolar 17 energies energies Pressure management 12 Pressure management Verification of the balance sheet input-output 12 Verification of the balance sheet inputoutput Management of complications 8 Consequences of the intraplasmatic passing 3 Complications management No violent movement 8 No violent movement Careful cervical ilatation 9 Careful cervical ilatation Correct hysteroscope fixing 9 Correct hysteroscope fixing Recommane operative time 6 Knowlege of the recommane operative To know to stop 5 time To know the place of hysteroscopy 5 Knowlege of the place of hysteroscopy Optic 0/30 management 3 Optic 0/30 management Mastering of the pelvic anatomy 4 Mastering of the pelvic anatomy Step by step hemostasis 3 Step by step hemostasis Inication of anti aherentials 4 Inication of anti aherentials Ergonomy 1 Ergonomy Full exploration of the cavity 1 Full exploration of the cavity 26/10/15 18

19 TABLEAU 3) Which surgical proceures have to be acquire? Answers N Gathering Polypectomy 18 Polypectomy Myomectomy 18 Myomectomy Enometrium ablation 17 Enometrium ablation Essure proceure 14 Essure proceure Vaginoscopy 10 Vaginoscopy Synechia 8 Synechia Septum 6 Septum Enometrium ablation with new technic Enometrium ablation with new technic 5 generation generation Retaine trophoblastic tissue 5 Retaine trophoblastic tissue IUD removal 2 IUD removal Resection without energy 2 Resection without energy Laparoscopy in case of perforation 4 Laparoscopy in case of perforation Knowlege of cervix's repair techniques 1 Knowlege of cervix's repair techniques 26/10/15 19

20 TABLEAU 4) If a simulator training program existe, which items shoul be inclue? Answers N Gathering Resection 16 Cervical ilatation 4 Possibility of technical proceures Essure proceure 6 Flui management 13 Flui Management Possibility of complications 12 Trauma 2 Possibility of complications ( perforation, Pain 1 bleeing,pain,trauma) Perforation 9 Bleeing 2 White balance 5 White balance Recognition of various pathologies 4 Recognition of pathologies Force feeback 3 Feeback of force Vizualise complete anatomy 3 Vizualize complete anatomy Different pelvic anatomies 1 Differents pelvic anatomies 26/10/15 20

21 TABLEAU 5) If a simulator program existe, which items woul you assess for the registrar's appraisal? Answers N Gathering No complication 14 Security 8 Pain 1 Absence of complication Resection not too eep 3 Minimal bleeing 2 Tren in space 2 Tren in space Percentage of resecte myoma 10 Percentage of resecte enometrium 8 Percentage of resecte pathology Operationnal uration 8 Operationnal uration Balance sheet input-output 6 Balance sheet input-output balance Success of realization of the proceure 6 Success of realization of the proceure Knowlege of its limits 6 Flui loss level 6 To know to stop Goo visibility 4 Goo visibility Knowlege of pathologies 4 Knowlege of pathologies Chips in only one time 2 Chips in only one time Constant spee for resection 2 Constant spee for resection Management of chips 1 Management of chips 26/10/15 21