Validity Evidence for the Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) Laparoscopic Skills

INTRODUCTION: Although the American Board of Obstetrics and Gynecology (ABOG) mandated passing the Fundamentals of Laparoscopic Surgery (FLS) for all graduating OBGYN residents in 2020, the validity evidence associated with FLS has been lacking. Meanwhile, OBGYN educators in collaboration with AAGL completed the development of the Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) program. EMIGS was subsequently studied in a construct validation trial that was conducted in 15 academic centers and included postgraduate year (PGY)1, PGY3, specialists (ABOG-certified specialists without subspecialty training), and experts (ABOG-certified specialists who had completed a fellowship in MIGS). The validity study demonstrated that more proficient participants performed tasks faster and with fewer errors than junior participants; however, how well the tasks were being performed has not yet been examined. Importantly, by determining the specific performance metrics that constitute a “passing” performance, these metrics can then be used to guide educators to more effectively coach trainees on EMIGS. OBJECTIVE: To further establish validity evidence by evaluating performances of the EMIGS laparoscopic tasks using a previously validated global rating scale for laparoscopic surgery (Global Operative Assessment of Laparoscopic Skills [GOALS]). METHODS: Expert laparoscopic educators, trained on the use of GOALS, evaluated video recordings of participants performing laparoscopic tasks (sleeve transfer, circle cut, extracorporeal knot tying, intracorporeal knot tying) from the EMIGS construct validation trial using modified GOALS. GOALS was developed and validated for assessing laparoscopic skills and consists of 5 items (depth perception, bimanual dexterity, efficiency, tissue handling, autonomy) with each item scored on a 5-point anchored Likert scale with higher scores indicating better performance. We modified GOALS by removing “autonomy”—this item was not relevant for analysis because participants were specifically instructed how to perform each task. RESULTS: We included 144 participants for whom recordings of the laparoscopic tasks were available; this included 54 PGY-1, 55 PGY-3, 20 specialists, and 15 experts. More proficient participants scored significantly better on GOALS (Table 1). There were also weak but significant correlations between GOALS scores and participant-reported laparoscopic and robotic clinical volume and FLS experience (r=0.21 to 0.50, P=0.016 to <0.005). There were weak to moderate inverse correlations between GOALS scores and time to task completion as well as errors for all the tasks (r=−0.28 to −0.731 P=0.02 to <0.005). Participants who completed each task within the allotted time limit also scored significantly better on GOALS. Importantly, participants who passed EMIGS scored better on GOALS (Table 2). CONCLUSIONS: More experienced participants and participants who passed EMIGS perform laparoscopic EMIGS tasks better when assessed using GOALS, as well as faster and with fewer errors. Importantly, those who passed EMIGS performed at a corresponding GOALS score of at least 3 (range 1–5) on all items (depth perception, bimanual dexterity, efficiency, tissue handling). These findings can be used to guide trainees and their coaches when preparing for this examination. This study adds important validity evidence further supporting EMIGS as a summative evaluation for OBGYN trainees.