Learning, Certification, and Credentialing for Endoscopic Surgery

Abstract

Most gynecologists learn their basic surgical procedures during residency. Those who pursue a fellowship have more extensive experience with normal and distorted pelvic anatomy. In decades past, further experience was achieved by working with a senior partner or by performing multiple surgical procedures over the years. Unfortunately, to some extent in recent years such common approaches to “learning” have not been permitted. New techniques (laparoscopy, hysteroscopy) and new procedures (e.g., laparoscopic-assisted vaginal hysterectomy, or LAVH) have come upon the scene with great rapidity. The number of surgical cases available to those in training (e.g., hysterectomy) has steadily declined, and the number of practicing gynecologists has increased. As a result of these primary factors (and others), relatively few gynecologists are well trained in the performance of “advanced” gynecologic endoscopy: (1) gynecologists who finished residency before 1988–1990 had no such training (except in specific locations); and (2) practicing physicians generally had limited opportunity to learn and to practice.