Highlight
- The Essentials in Minimally Invasive Gynecologic Surgery (v-ESSENTIALS) manual skills exam demonstrates strong validity as a summative assessment for laparoscopic proficiency.
- There is a significant positive correlation between v-ESSENTIALS performance and scores on the validated Global Operative Assessment of Laparoscopic Skills (GOALS).
- Experienced surgeons and those passing v-ESSENTIALS consistently achieve higher GOALS scores, supporting GOALS as a preparatory proxy for v-ESSENTIALS.
- v-ESSENTIALS assessment supports structured competency-based certification in minimally invasive gynecologic surgery training.
Study Background
Minimally invasive gynecologic surgery (MIGS) offers multiple patient benefits including reduced morbidity and faster recovery. However, acquisition of laparoscopic skills is technically demanding and requires rigorous training and assessment to ensure surgical competence. The Essentials in Minimally Invasive Gynecologic Surgery (v-ESSENTIALS) manual skills exam was introduced as a new qualifying examination by the American Board of Obstetrics and Gynecology (ABOG) to serve as an objective summative evaluation tool for board certification candidates. Demonstrating the validity of the v-ESSENTIALS exam is critical to justify its use for high-stakes decisions about surgeon credentialing and training progression.
Previous studies have highlighted the utility of global rating scales, such as the Global Operative Assessment of Laparoscopic Skills (GOALS), as reliable and valid tools for assessing laparoscopic skill performance across specialties. This study aimed to investigate the validity evidence for the v-ESSENTIALS exam by correlating scores from its laparoscopic tasks with GOALS ratings, thereby linking v-ESSENTIALS performance to a well-established benchmark.
Study Design
This observational study analyzed video-recorded performances of laparoscopic tasks from the v-ESSENTIALS construct validation trial. The cohort included 144 participants stratified by training level: 54 postgraduate year 1 residents, 55 postgraduate year 3 residents, 20 ABOG-certified obstetrics and gynecology attendings, and 15 ABOG-certified attendings who completed MIGS fellowship training.
Participants performed five laparoscopic tasks central to the v-ESSENTIALS exam: sleeve transfer, circle cut, extracorporeal knot tying, intracorporeal knot tying, and running stitch. Expert laparoscopic educators blinded to participant identity and training level reviewed these videos. They scored each task using a modified GOALS scale encompassing four domains: depth perception, bimanual dexterity, efficiency, and tissue handling. Each domain was rated on a 5-point anchored Likert scale, with higher scores indicating better performance.
Statistical analysis employed Spearman correlation coefficients to examine the relationship between GOALS domain scores and v-ESSENTIALS outcome metrics, including task completion time and errors. Wilcoxon rank-sum testing compared GOALS scores between participants passing versus failing the v-ESSENTIALS exam. Weighted kappa statistics assessed inter-rater agreement. All analyses used R software (version 4.3.1).
Key Findings
The study confirmed that participants with greater experience and proficiency performed better on GOALS across all task domains. This was illustrated by higher median GOALS scores for attendings, especially those with MIGS fellowship training, compared to junior residents.
Significant negative correlations were observed between GOALS scores and both time to task completion and total error count (correlation coefficients ranged from r=0.55 to 0.70 and r=0.28 to 0.55 respectively, with P-values <.001), indicating that higher quality laparoscopic skills were associated with faster, safer task execution.
Notably, participants who passed the v-ESSENTIALS practical exam had median GOALS individual item scores ranging from 3 to 3.5 on the 5-point scale, reflecting intermediate to advanced skills, while those who failed scored predominantly 1 to 2, indicating lower proficiency. Across GOALS domains (depth perception, bimanual dexterity, efficiency, tissue handling), a GOALS score of at least 3 consistently aligned with successful v-ESSENTIALS completion.
Inter-rater reliability for GOALS scoring was substantial, reinforcing that GOALS provides reproducible and objective assessment metrics.
Expert Commentary
The findings reinforce the growing consensus that structured, objective performance assessments like the v-ESSENTIALS exam are crucial for confirming surgical readiness in MIGS. The correlation with GOALS, a widely validated measure, adds important criterion validity evidence supporting its high-stakes use.
Given that GOALS scoring systems are nonproprietary, accessible, and straightforward to implement, they may serve as valuable benchmarking tools for candidates preparing for the v-ESSENTIALS exam. This is particularly relevant because v-ESSENTIALS relies on proprietary metrics that are not publicly available, limiting transparency during the preparation phase.
However, the study has limitations including its observational design, and reliance on video assessments which may omit intraoperative contextual factors. Furthermore, the sample size of certified MIGS attendings, though reflective of early adopters, was relatively small. Future research should evaluate longitudinal outcomes related to patient safety and surgical performance after certification via v-ESSENTIALS.
Conclusion
This study substantiates the validity of the Essentials in Minimally Invasive Gynecologic Surgery manual skills exam as a summative evaluation for laparoscopic competency in obstetrics and gynecology trainees. Performance on v-ESSENTIALS corresponds well with scores on the Global Operative Assessment of Laparoscopic Skills tool, particularly across key technical items. Implementation of v-ESSENTIALS holds promise to standardize certification by ensuring that candidates meet minimum laparoscopic proficiency standards associated with clinical safety and efficiency.
Moreover, GOALS ratings can be practically employed as proxy benchmarks for candidates during preparation for v-ESSENTIALS, addressing current limitations from the unavailability of proprietary scoring metrics. Overall, these results advance competency-based certification approaches in MIGS and enhance quality assurance frameworks in gynecologic surgery training.
Funding and Clinical Trials
The present study utilized data from the ABOG construct validation trial; specific funding disclosures were not detailed in the source. No clinical trial registration was noted.
References
- Grace Chen CC, et al. Validity evidence for the Essentials in Minimally Invasive Gynecologic Surgery laparoscopic skills: correlation with the Global Operative Assessment of Laparoscopic Skills. Am J Obstet Gynecol. 2026 Mar;235(1):214-220. PMID: 41785985.
- Vassiliou MC, Ghitulescu GA, Feldman LS, et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg. 2005;190(1):107-113.
- American Board of Obstetrics and Gynecology. Essentials in Minimally Invasive Gynecologic Surgery: Candidate Manual. ABOG Website. 2023.
- Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2008;(4):CD006575.