Learning Curves of Gynecologic Residents Preparing for the EMIGS Manual Skills Exam

INTRODUCTION: Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) is a comprehensive program designed by the American Association of Gynecologic Laparoscopists (AAGL) to train and assess gynecologic (GYN) residents in the essential skills and knowledge of minimally invasive gynecologic surgery (MIGS). This program was designed to replace the Fundamentals of Laparoscopic Surgery (FLS) program, which was not specific to gynecology, with one that is more targeted to GYN surgery. To the best of our knowledge, no prior publications have addressed preparation for the EMIGS manual skills exam, and the learning curves of GYN residents as they practice EMIGS tasks have not been described. OBJECTIVE: To describe GYN resident practice patterns and learning curves as they prepare for the EMIGS manual skills exam and to compare their performance metrics during practice to the metrics of third-year residents and MIGS attendings, based on published validity studies. METHODS: This is a prospective observational study of GYN resident physicians from April 2023 to March 2024 at a single institution. Residents and their coach recorded details of their EMIGS practice sessions, such as time to completion, number of sessions, and proficiency metrics for each task repetition. Time to completion of skills was specifically compared to the number of repetitions to create composite learning curves for resident physicians. RESULTS: Sixteen GYN residents participated in the study (postgraduate years 1–4). The median number of repetitions for each task ranged from 5.5 to 10.5. The average number of hours spent practicing was 10.4. Learning curves showed the greatest rate of improvement in the first 3 to 5 number of repetitions (Figure 1). First-year residents initially had steeper learning curves than more senior residents (Figure 2). All residents passed the EMIGS manual skills exam. CONCLUSIONS: This training program improved performance metrics when preparing for the EMIGS manual skills exam. Residents needed relatively short periods of practice to achieve proficiency. Based on findings from this pilot study, training programs are feasible given the limitations of busy resident schedules and beneficial for residents preparing to pass the EMIGS manual skills exam.