Validity evidence for the Essentials in Minimally Invasive Gynecologic Surgery laparoscopic skills: correlation with the Global Operative Assessment of Laparoscopic Skills

Chi Chiung Grace Chen; Liron Bar-El; Jaime B Long; Anja Frost; Cara R King; Adi Katz; Nash S Moawad; Barbara Levy; Haotian Wu; Veronica Lerner

doi:10.1016/j.ajog.2026.02.040

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 3:S0002-9378(26)00123-7. doi: 10.1016/j.ajog.2026.02.040. Online ahead of print.

Authors

Chi Chiung Grace Chen¹, Liron Bar-El², Jaime B Long³, Anja Frost⁴, Cara R King², Adi Katz⁵, Nash S Moawad⁶, Barbara Levy⁷, Haotian Wu⁸, Veronica Lerner⁵

Affiliations

¹ Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ccgracechen@gmail.com.
² Section of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH.
³ Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Penn State College of Medicine, Hershey, PA.
⁴ Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Departments of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
⁶ Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL.
⁷ Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego Health Sciences, La Jolla, CA.
⁸ Department of Environmental Health Sciences, Columbia University, New York, NY.

PMID: 41785985
DOI: 10.1016/j.ajog.2026.02.040

Abstract

Background: The Essentials in Minimally Invasive Gynecologic Surgery manual skills examination is a new qualifying examination for board certification in obstetrics and gynecology. The aim of this study is to examine the validity evidence for the use of Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation by assessing performance of laparoscopic tasks (sleeve transfer, circle cut, extracorporeal knot tying, intracorporeal knot tying, and running stitch) using a previously studied global rating scale for laparoscopic surgery (Global Operative Assessment of Laparoscopic Skills).

Study design: Expert laparoscopic educators evaluated video recordings of participants performing laparoscopic exercises from the Essentials in Minimally Invasive Gynecologic Surgery construct validation trial using the modified Global Operative Assessment of Laparoscopic Skills (depth perception, bimanual dexterity, efficiency, and tissue handling), scoring them on a 5-point anchored Likert scale with higher scores indicating better performance. Spearman's correlation tests were used to assess correlations among scores, and Wilcoxon rank-sum tests were used to compare groups. Weight kappa statistics were calculated to assess inter-rater agreement. All statistical analyses were conducted on R 4.3.1.

Results: We included 144 participants: 54 postgraduate year 1 residents, 55 postgraduate year 3 residents, 20 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings, and 15 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings who completed a Minimally Invasive Gynecologic Surgery fellowship. We demonstrated that more proficient participants achieved higher Global Operative Assessment of Laparoscopic Skills scores. There were weak to moderate negative correlations between Global Operative Assessment of Laparoscopic Skills scores and time to task completion as well as total number of errors for each exercise (r=0.55-0.70, P<.001; r=0.28-0.55, P=.003 to P<.001, respectively). Participants who passed Essentials in Minimally Invasive Gynecologic Surgery scored better on Global Operative Assessment of Laparoscopic Skills (passed: median individual item Global Operative Assessment of Laparoscopic Skills scores (interquartile range) 3 to 3.5 [2, 4] vs failed: 1 to 2 [1, 3], P<.001-.08).

Conclusion: More experienced participants and participants who passed Essentials in Minimally Invasive Gynecologic Surgery perform laparoscopic Essentials in Minimally Invasive Gynecologic Surgery exercises with better skills. Importantly, those who passed Essentials in Minimally Invasive Gynecologic Surgery performed at a corresponding Global Operative Assessment of Laparoscopic Skills score of at least 3 (range, 1-5) for all the items (depth perception, bimanual dexterity, efficiency, and tissue handling). Given that Global Operative Assessment of Laparoscopic Skills are easy to use and widely available, while Essentials in Minimally Invasive Gynecologic Surgery metrics are proprietary and cannot be accessed, Global Operative Assessment of Laparoscopic Skills can be used as a proxy for the Essentials in Minimally Invasive Gynecologic Surgery passing score during preparation. In addition, our study adds to the body of validity evidence, further supporting Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation for obstetrics and gynecology trainees.

Keywords: deliberate practice; gynecology; laparoscopy; performance assessment; qualifying board examination; residents; self-directed practice; simulation; surgical coaching; surgical education.