The development and psychometric validation of a low-cost anthropomorphic 3D-printout simulator for training basic skills applicable to office-based hysteroscopy

Background Hysteroscopy training requires the development of specific psychomotor skills. Few validated low-cost models exist in hysteroscopy. The main objective of this study is to determine face, content, and construct validity of a simulator designed for training basic hysteroscopy skills applied to office-based hysteroscopy. Methods Twenty-five hysteroscopy experts and 30 gynecology residents participated in this prospective observational study. The simulator consisted of three color-textured, silicone-coated anthropomorphic 3-dimensional (3-D) printout uterine models inside a box. Each uterine model in the simulator was designed to develop one of the following basic hysteroscopic skills: hysteroscopic navigation, direct biopsy, and foreign body removal. Participants performed five video-recorded simulation attempts on each model. Procedure-specific checklists were used to rate performance. Results Median scores (25th-75th percentiles; p-value) 4 (3-4; p < 0.001) and surgical experience associated to the simulated procedures 4 (3-4; p < 0.001) indicated positive perceptions as to the realism of the internal cavity of the simulator. Median scores of 4 (3-4; p < 0.001) were assigned to the realism and utility of the tasks performed in the simulator for enhancing novice training in hysteroscopy. Expert performance scores were significantly higher and task completion times were significantly lower than those of novices in the navigation exercise (F-(1,F-53) = 56.66; p < 0.001), the directed biopsy exercise (F-(1,F-53) = 22.45; p < 0.001), and the foreign body removal exercise (F-(1,F-53) = 58.51; p < 0.001). Novices' performance improved on all three exercises: navigation exercise (F-(1,F-53) = 182.44; p < 0.001), directed endometrial biopsy (F-(1,F-53) = 110.53; p < 0.001), and foreign body removal (F-(1,F-53) = 58.62; p < 0.001). Experts' task completion times were significantly lower when compared to that of novices in the five attempts (p < 0,001) of the exercises: navigation (F-(1,F-48) = 25.46; p < 0.001), directed biopsy (F-(1,F-46) = 31.20; p < 0.001), and foreign body removal (F-(1,F-50) = 69.8; p < 0.001). Novices' task completion times diminished significantly throughout the sequence of exercises. Conclusions The low-cost simulator designed for the acquisition of basic skills in hysteroscopy demonstrated face, content, and construct validity.