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Optimizing resident operative self-confidence through competency-based surgical education modules: are we there yet?

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Introduction and hypothesis

Self-confidence is the belief in one’s ability to perform and can be enhanced by training. Surgical education should aim to optimize trainee confidence. We designed three procedure-specific competency-based modules to teach vaginal hysterectomy (VH), anterior (AR) and posterior repair (PR) to novice gynecology residents. We hypothesized each module would improve self-confidence and satisfaction during index procedure performance in the operating room.


This was an ancillary analysis of a larger randomized-controlled trial of gynecologic educational interventions. Residents at three Canadian universities were included if they had previously performed fewer than five index procedures independently. Intervention residents received educational modules; controls engaged in self-directed learning. All residents performed one or more of the three surgeries and filled out a validated Self-Confidence Scale and a Satisfaction Scale. Scores were compared between groups. Correlations were sought between self-confidence and various variables.


Forty-six residents at three Canadian universities were randomized (21 intervention, 25 control). Most residents had never performed the index procedure. Overall, self-confidence was significantly higher (p = 0.021) in the intervention group for VH, but not for AR and PR (p = 0.94 and p = 0.12, respectively). Compared with controls, self-confidence was also significantly higher in intervention residents who had never performed VH (p = 0.026) or PR (p = 0.027) and in first and second year intervention residents. There was a positive correlation between self-confidence and satisfaction.


Surgical modules improved self-confidence preferentially in the most junior residents and for more complicated procedures. The wide self-confidence ranges observed suggest that optimization should be an important goal for surgical educators.

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Financial support from a Medical Education Research Grant (competitive), the Royal College of Physicians and Surgeons of Canada. The funding source did not have any role in any aspect of this research.

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Correspondence to Roxana Geoffrion.

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Conflicts of interest

• R Geoffrion: Preceptor/proctor Boston Scientific Capio and Obtryx devices; Advisory Board Duchesnay.

• N Todd: Advisory board, Bayer Pharmaceuticals.

• Remaining authors claim no conflict of interest.

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Meeting presentation

Poster, Association of Academic Professionals in Obstetrics and Gynecology/Society of Obstetrics and Gynecology Canada Ontario Continuing Medical Education conference, Toronto Ontario, Canada, December 1–3, 2017.

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Geoffrion, R., Koenig, N.A., Sanaee, M.S. et al. Optimizing resident operative self-confidence through competency-based surgical education modules: are we there yet?. Int Urogynecol J 30, 423–428 (2019).

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