EMIGS: Look How Far We’ve Come….

AAGL’s Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) was developed by hundreds of expert educators over the past 12 years using the most sophisticated psychometric, statistical, and validation methods. This steadfast dedication and sincere efforts were ultimately crowned with the approval of the American Board of Obstetrics and Gynecology (ABOG) in May 2022 as the only GYN-specific test that fulfills the Surgical Skills Program standard for ABOG certification.

The EMIGS program was built on three pillars: A Didactic web-based suite with over 80 narrated video lectures, and validated, virtually proctored, Cognitive and Manual Skills exams.

Since its roll out in early 2023, the EMIGS Cognitive exam has been taken by 522 residents and the Manual Skills exam has been taken by 371 residents, with a total of 1,465 residents from 163 OBGYN residency programs registered for EMIGS. In addition, 993 practicing physicians have signed up to use the Didactic suite for continuing education and to prepare for the Minimally Invasive Gynecologic Surgery Focused Practice Designation exam offered by ABOG.

This impressive leap in OBGYN surgical training and testing is only the beginning. The EMIGS Steering Committee and the AAGL staff are tirelessly working to strengthen the program, update it, and add more resources for our trainees and physicians in practice.

We continue to develop additional modules for EMIGS Didactics. Two new modules have been added on the surgical approaches to hysterectomy and on safe and efficient office procedures including office hysteroscopy. The content is carefully curated and developed by expert educators in the field. Once residents are enrolled in EMIGS, they have 3-years of unlimited access to the lectures, using the Didactic curriculum as a resource throughout their residency training.

On the EMIGS Cognitive exam front, a large committee of dedicated educators and subject matter experts (SMEs), along with expert psychometricians, are actively working on the analysis of the exam content and blueprint, updating and adding questions, enriching the content and ensuring the program remains up-to-date and evidence-based, reflecting the constant progress in our field.

We continue to optimize our virtually proctored exams, and to evaluate candidates’ performance on the Cognitive and Manual Skills exams. Our team seeks innovative solutions to facilitate and streamline test scheduling, execution, grading, and reporting. The AAGL EMIGS team has expanded with additional graders hired and trained to accommodate the increasing volume, ensuring timely and reliable state of the art grading protocols and quality control.

AAGL and EMIGS have partnered with Hologic and Inovus through a generous educational grant to elevate resident training by providing innovative hysteroscopic and laparoscopic platforms to all ACGME-accredited OB/GYN residency programs in the United States. These Augmented Reality (AR)-enabled simulators are offered to strengthen our residents training in laparoscopy and hysteroscopy. The HystAR has already been rolled out to numerous residency programs across the US, with a hysteroscope, laptop, uterine model, and hysteroscopic instruments.  Meanwhile, Inovus and the EMIGS team are finalizing the development of the new LapAR box trainer, specially designed for EMIGS training and testing. We are excited to be rolling out this high-quality innovative box trainer to our residency programs in the next few weeks. We look forward to exploring the power of Artificial Intelligence (AI) in training and assessment with the addition of the LapAR and HystAR platforms.

Our EMIGS Research Subcommittee has had a busy season. The new EMIGS Research Award has been offered, in collaboration with the Foundation of the AAGL. Thanks to a generous endowment of $80,000, the Foundation and EMIGS are offering $10,000 annually to support Simulation Research. We have received an overwhelming number of grant submissions for this first cycle, with numerous excellent proposals that are sure to strengthen and elevate EMIGS as a staple in Gyn surgical education. The proposals have been methodically graded and vetted by an expert committee of researchers and educators, and we are very excited to take this opportunity to announce the winners of this inaugural cycle of EMIGS Research Awards:

• University of Pennsylvania. PI: Annie Apple, MD
  Impact of an EMIGS Curriculum on Operating Room (OR) Skills and Experiences.
• Loyola University. PI: Laura Glaser, MD
  Validation of Assessment Scores for OBGYN Residents Completing the EMIGS “Running Stitch” Task – a Multi-Center Study
• Columbia University. PI: Jessica Chaoul, MD
  Improvement in Surgical Efficiency Following Implementation of EMIGS: A Longitudinal Study
• Danbury Hospital. PI: Jaqueline Early, MD
  Comparing Manual Skills Training from FLS to EMIGS in Vaginal Cuff Closure

We can’t wait to see the numerous presentations, publications, and the body of literature on EMIGS produced by these amazing teams. A new cycle for EMIGS Research Grant proposals is now open. Don’t wait to submit your research idea to take advantage of this opportunity and add a building block towards the future of MIGS simulation.

While our team is actively engaged in these initiatives among many others, making EMIGS available to the international community and to practicing physicians is one of our prime goals. We have started working with our psychometricians and our Standard-Setting Committee to explore setting appropriate performance standards for physicians in practice, to start offering EMIGS for practicing surgeons in the US and internationally.

EMIGS is truly one of the AAGL’s crowning achievements. We give our sincere gratitude to the EMIGS Steering Committee members, the twelve AAGL Boards who held the vision, the AAGL staff who continue to work tirelessly behind the scenes, to the numerous faculty members who developed and continue to enhance the EMIGS program, to the hundreds of volunteers who participated in the pilot studies, and to the almost 1500 residents, 163 residency programs and 1,000 practicing physicians who have partnered with us to shape the future of Gyn surgical training and assessment.

Visit the AAGL EMIGS website for more information. Please contact Kyle Hicks, EMIGS Manager at khicks@aagl.org with any questions.