The following curriculum has been developed utilising the RCOG core curriculum and the surgical ATSM curriculums.
The theoretical elements have been linked to CIPs and the structured simulation programme can be utilised by trainees to show evidence of competence. The theoretical and knowledge based elements can be covered in lecture based learning and the practical elements covered using simulation equipment.
It is suggested that the basic curriculum is covered by all trainees at ST1-2 level, intermediate by all trainees at ST3-7 level and advanced by trainees undertaking the gynaecology surgical ATSMs at ST6-7 level. Further training may be developed to support the surgical subspecialty training programmes such as urogynaecology and gynaecological oncology. The aim of the this structured curriculum is building theoretical knowledge linked to the RCOG curriculum while allowing the trainee opportunities to develop key hand eye co-ordination and dexterity skills which they can regularly practice and develop as they move through the curriculum from basic to advanced. Allowing for variations in hub structures and methods for delivering the curriculum, it is recommended the theory and practical elements of the curriculum can be covered over 3-5 days which should be taken as study leave. An example of a model hub and curriculum are detailed in appendix 3.
Basic
Theoretical element:
- Manages acute pelvic pain in the non-pregnant woman
- Manages vaginal bleeding in the non-pregnant woman
- Manages acute infections
- Manages acute complications of gynaecological treatment
- Manages vaginal bleeding and pain in early pregnancy
- Manages other early pregnancy complications
- Manages the acute gynaecological workload
- Manages abnormal vaginal bleeding
- Manages pelvic and vulval pain
- Manages pelvic masses
- Manages subfertility
Knowledge base:
- Theatre environment (setup, ergonomics)
- Pelvic anatomy
- Electrosurgery
- Laparoscopic entry techniques
- Laparoscopic equipment
- Diagnostic laparoscopic
- Dissection techniques
- Ectopic pregnancy
- Surgical complications
- Introduction to suturing techniques
Practical exercises:
- Basic hand eye co-ordination exercises
- Diagnostic laparoscopy - entry simulation (OSAT)
- Electrosurgery hands on
- Needle handling
Intermediate
Theoretical element:
- Manages acute pelvic pain in the non-pregnant woman
- Manages vaginal bleeding in the non-pregnant woman
- Manages acute infections
- Manages acute complications of gynaecological treatment
- Manages vaginal bleeding and pain in early pregnancy
- Manages other early pregnancy complications
- Manages the acute gynaecological workload
- Manages abnormal vaginal bleeding
- Manages pelvic and vulval pain
- Manages pelvic masses
- Manages subfertility
Knowledge base:
- Theatre environment (setup, ergonomics) + laparoscopic equipment
- Pelvic anatomy – introduction to sidewall anatomy + pelvic nerves
- Electrosurgery
- Laparoscopic entry techniques
- Ectopic pregnancy – diagnosis and surgical management
- Laparoscopic salpingo-oophorectomy
- Ovarian pathology including US findings
- Ovarian cystectomy
- Anaesthetic considerations for laparoscopic surgery
- Surgical complications – urinary tract
- Surgical complications – bowel
- Surgical complications – vessels and major haemorrhage
- Tissue retrieval techniques
- Suturing techniques
Practical exercise:
- Basic hand eye co-ordination exercises
- Diagnostic laparoscopy - entry simulation (OSAT)
- Ovarian cystectomy simulation (OSAT)
- Laparoscopic management of an ectopic pregnancy salpingectomy simulation (OSAT)
- Laparoscopic management of an ectopic pregnancy salpingostomy simulation (OSAT)
- Suturing and knot tying
Advanced
Theoretical element:
- Manages preoperative planning and case selection
- Recognises and manages delayed-onset complications
- Counsels patients before and after receiving treatment
- Manages laparoscopic gynaecological surgery relying on a number of techniques and procedures
- Recognises and manages intraoperative complications, including when to convert to an open procedure
- Able to recognise bowel and bladder complications of surgery
Knowledge base:
- Theatre environment (setup, ergonomics) + laparoscopic equipment
- Pelvic anatomy –sidewall anatomy including neuroanatomy
- Laparoscopic suturing
- Total laparoscopic hysterectomy
- Subtotal laparoscopic hysterectomy
- Laparoscopic myomectomy
- Tissue extraction techniques including morcellation
- Endometriosis surgery including excision
- Pelvic abscess management
- Surgical complications – urinary tract
- Surgical complications – bowel
- Surgical complications – vessels and major haemorrhage
- Consent
- Ureterolysis
Practical exercise:
- Laparoscopic suturing
- Myomectomy simulation
- Laparoscopic hysterectomy simulation
- Tissue retrieval techniques including morcellation
- Ovarian cystectomy simulation (OSAT)
- Endometriosis excision simulation