Standing on the shoulders of giants: contemplating a standard national curriculum for surgical training in gynaecology.

Surgical gynaecology is mostly taught in the operating room. Few training programs organize structured surgical skill laboratories, and even fewer conduct a formal, objective surgical proficiency assessment at the completion of training. Articles published in English between 1950 and 2008 that described surgical curricula for training outside the OR were sought using Medline and the key words "resident," "gynecology," and "surgery." In this review, examples of structured curricula from the disciplines of obstetrics and gynaecology and general surgery are provided. The key features of an effective curriculum are realism, valid assessment tools, retention of skill over time, transferability to real OR situations, and cost efficiency. Training models such as bench and video trainers and virtual reality simulators have been reliably shown to produce quantifiable improvement in skills that is transferable to surgical procedures in live patients. Training laboratories are expensive to develop and maintain but may be more cost-effective than training residents solely in the OR. Having a standard national curriculum for surgical skill enhancement remote from the OR is highly desirable. Frequent assessment of learning progress using validated tools should also be considered.