COMMENTARY

Improving Training in Minimally Invasive Ob/Gyn Surgeries

How to Expand Access While Making Procedures Safer

Andrew M. Kaunitz, MD

Disclosures

January 06, 2014

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Hello. I am Andrew Kaunitz, Professor of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Looking over the horizon to 2014 and beyond, an issue that looms for those who perform gynecologic surgery involves what may appear to be conflicting goals: assuring quality of gynecologic surgical services while maintaining and improving access.

A recent editorial[1] and article[2] in the ACOG (American Congress of Obstetricians and Gynecologists) "Green Journal" highlighted a number of factors that affect quality and access, including:

Medical management options to treat abnormal uterine bleeding continue to improve, meaning that fewer women are undergoing hysterectomy.

Although our patients are clearly benefitting from the shift towards minimally invasive approaches, older gynecologists all too often have not been trained in laparoscopic and robotic approaches, and some recently graduated or current residents may receive insufficient training in this area.

More than 1 in 5 male physicians and more than 1 in 3 female physicians are working part-time, proportions much higher than a decade ago. Those who are working part-time and continuing to perform surgery may face challenges in maintaining their skills.

An expanding literature is documenting that the patients of high-volume surgeons experience less morbidity and mortality than the patients of lower-volume surgeons.

Given these observations, some might conclude that only high-volume surgeons should be awarded credentials to perform minimally invasive major gynecologic surgeries. The Green Journal articles, however, point out that rushing to limit the number of operating surgeons can create barriers to obtaining surgical care, particularly in rural areas, which may be served by few ob/gyn specialists.

The conundrum outlined by these articles underscores the need for innovative approaches to assuring surgical and overall clinical competency. One approach mentioned is the development of regional, multidisciplinary simulation centers that can enhance skills among participating surgeons. Another is the development of innovative tools to assess surgical competency -- tools that will probably play a role in future credentialing.

Finally, redesigning group practices so that some providers, for example, focus on performing surgery, others on inpatient obstetric care, and others on office practice will allow all clinicians to be that much more proficient in their own areas of expertise.

Thank you. I am Andrew Kaunitz.

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