That gap between perceived readiness and demonstrated independent performance is the core problem PROMOTE addresses. It's compounded by shrinking operative exposure: the average total operative training time in General Surgery is 3,963 hours — just 20.6% of five years of 80-hour work weeks — and Ob/Gyn residents spend significantly less time in the OR per year than General Surgery residents (4.9 vs. 8.5 months/yr, p=0.001).
● The Story of PROMOTE
A surgical education journey
Why PROMOTE was built, how it works, and how it was validated — from a decade of published research into gynecologic surgical training.
01 · The Problem
We lack summative tools
Surgical competence has traditionally been judged through subjective, formative assessment — and that assessment gap is widening as operative experience shrinks.
Self- & program-reported
69% / 90%
of graduating residents and residency program directors affirm resident ability to independently perform a vaginal hysterectomy
VS
Actual independent performance at fellowship entry
20% VH23% AR30% PR
reported by fellowship program directors
3,963 hrsAverage total operative training time in General Surgery residency
20.6%Of a 5-year, 80-hr/week residency spent operating
4.9 vs 8.5Months/yr in the OR: Ob/Gyn vs. General Surgery (p=0.001)
p = 1No difference in resident PGY-level between trial arms — a clean comparison
And subjective assessment carries implicit bias
Where assessment stays subjective, several documented biases shape the result — consistently disadvantaging some trainees with more critical reviews, fewer positive comments, and less operative autonomy.
Gender bias
Race / ethnicity bias
Mentor–mentee familiarity bias
Affinity bias
02 · The Precedent
Simulation-to-proficiency already works
FLS
Fundamentals of Laparoscopic Surgery established the model: a randomized controlled trial showed that simulator training to proficiency improves real operating-room performance. PROMOTE applies the same "train to proficiency, then prove it transfers" logic to open vaginal surgery.
03 · The Approach
PROMOTE: PROcedure-specific MOdular Training and Evaluation
Started circa 2012. A five-stage learning flow built around three procedures — vaginal hysterectomy, anterior repair, posterior repair.
1
Baseline
Recruitment & pre-test of baseline knowledge
→
2
Didactic
Procedure-specific online modules
→
3
Post-test
Knowledge check
→
4
Simulation
Low-fidelity models, guided then self-practice
→
5
OR Evaluation
Transfer of skill assessed in the real OR
A scoring system based on time and errors underpins every simulation session — giving each learner an objective, reproducible score rather than a subjective impression.
04 · The Validation
Tested in a randomized controlled trial
Face & content validity, interrater reliability, internal consistency, and construct validity — measured across all three procedure models.
28 videos rated across 6 intervention and 8 control residents (PGY1–PGY4), with no significant difference in resident level between groups (p=1). No resident had independently performed AR, PR, or VH before recruitment. Groups were balanced by age (28.8 vs. 29.6 yrs, p=0.54) and sex.
📋
Face & content validity
Established via feedback from RCT collaborators and gynecologic surgeons at the Western Society of Gynecologic Surgeons.
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Interrater reliability (ICC)
Anterior Repair0.90
Posterior Repair0.89
Vaginal Hysterectomy0.76
📐
Internal consistency (Cronbach's α)
Anterior Repair0.85
Posterior Repair0.80
Vaginal Hysterectomy0.71
Construct validity: scores rose significantly with operator skill level — from control resident, to intervention resident, to fellow/staff — consistent across all three models (Jonckheere-Terpstra test, blinded assessors, disguised performance order).
05 · What Else We Found
Both formative and summative feedback are needed
✓ Pass-fail score established for each module
✓ Skill transferred to the real OR in novice residents (mostly VH & PR), evaluated via global rating scale
✓ Improved self-confidence in novice residents
✓ Improved satisfaction for vaginal hysterectomy training
06 · Implementation
What it takes to run
Real staffing and time costs from implementing PROMOTE into standard second-year resident education.
People
- 8 residents at the PGY-2 level (novice surgical learners)
- 4 attending staff preceptors for practice sessions
- 1 proctor for didactic/practical exam administration & scoring
Protected time
- 3 hrs — AP & VH didactic modules with corresponding exams
- 3 hrs — AP repair practice
- 3 hrs — VH practice, with individual practical exams (1 hr each)
⏱ Approx. 10 hours per resident, total
See the full evidence base
Read the peer-reviewed publications behind PROMOTE, or watch Dr. Geoffrion present the research.