Using virtual-reality simulation to ensure basic competence in hysteroscopy



Hysteroscopy is a technically challenging procedure. Specialty curricula of obstetrics and gynaecology appraise hysteroscopy for trainees but there is no present evidence-based training program that certifies the fundamental technical skills before performance on patients. The objectives of this study were to develop and gather validity evidence for a simulation-based test that can ensure basic competence in hysteroscopy.


We used the virtual-reality simulator HystMentor™. Six experts evaluated the feasibility and clinical relevance of the simulator modules. Six modules were selected for the test and a pilot study was carried out. Subsequently, medical students, residents, and experienced gynaecologists were enrolled for testing. Outcomes were based on generated simulator metrics. Validity evidence was explored for all five sources of evidence (content, response process, internal structure, relations to other variables, consequences of testing).


Inter-case reliability was high for four out of five metrics (Cronbach’s alpha ≥ 0.80). Significant differences were identified when comparing the three groups’ performances (p values < 0.05). Participants’ clinical experience was significantly correlated to their simulator test score (Pearson’s r = 0.49, p < 0.001). A single medical student managed to achieve the established pass/fail score (6.7% false positive) and three experienced gynaecologists failed the test (27.3% false negative).


We developed a virtual-reality simulation-based test in hysteroscopy with supporting validity evidence. The test is intended to ensure competency in a mastery learning program where trainees practise on the simulator until they are able to pass before they proceed to supervised training on patients.

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The authors thank senior consultant, Ivan Moulun Grunnet, an experienced hysteroscopist, for his contribution to the test contents.


The study did not receive any funding or financial support.

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Corresponding author

Correspondence to Mona M. Savran.

Ethics declarations


The authors Mona M. Savran, Anders Bo Nielsen, Bente Bækholm Poulsen, Poul Bak Thorsen, and Lars Konge have no conflicts of interest or financial ties to disclose.

Ethical approval

Ethical approval was granted by the local ethics committee (S-20172000-10) on 16 January 2017.

Informed consent

Written informed consent was obtained from all participants before enrolment.

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Savran, M.M., Nielsen, A.B., Poulsen, B.B. et al. Using virtual-reality simulation to ensure basic competence in hysteroscopy. Surg Endosc 33, 2162–2168 (2019).

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  • Hysteroscopy
  • Gynaecology
  • Education
  • Virtual reality
  • Simulation training