Hysteroscopic Skills Training and Testing Model

Training and assessment of hysteroscopic psychomotor skills


The model uses the specific uterine environment and approach as a model for the exercises. More and more European administrations and legal bodies are questioning the risks of the “see one, do one, teach one”-method and are forcing the medical communities to develop validated training concepts prior to enter a clinical situation.

Training in hysteroscopic diagnosis and surgery should implement, besides the typical surgical skills, the so called Hysteroscopic Psychomotor Skills (HPS). Those typical skills needed to work in a ‘key-hole’ situation, such as hand-eye coordination, camera navigation, and fine motor skills for remote handling of instruments without tactile feedback. Virtual reality models have been proposed in this regard but as they are still very expensive a simple and broad implementation (i.e. not at specialized centres) is not feasible today, at least not in the developing countries.



Mentees can train and test, prior to entering the clinical teaching programme, depth perception on a 2D video screen, remotely handle instruments without tactile feedback, develop hand-eye coordination and fine motor skills. Once validated, HYSTT is an in-vitro psychomotor skills training and testing method that offers zero-based scoring, progress assessment and certification. The results of the exercises are measured in the objective time to correct performed exercise.

The fully new Hysteroscopic Skills Training and Testing (HYSTT) model represents the spatial distribution and orientation of the different planes and angles of a normal uterus. This inanimate model, placed in a trainer box, is easy to install, flexible and allows for cost-efficient application.


Hysteroscopic skill ex: hystt the european academy of gynaecological surgery

The Exercises

Excercises are done in pair. Maximal time per excercise is 180 minutes. As +he Academy is the custodian of benchmark data from various mentees, each with their specific level of expertise, a mentee can be scored and positioned versus these benchmark data. Both exercises are timed and are limited by a maximum. A combination of correctly executed positions and time calculation is the base for the individual scores on the two exercises for the mentee.

HYSTT 1: Bachelor level

EXERCISE 1: camera navigation

This test evaluates the skills of an individual to handle the camera and work with a 30°optic in an hysteroscopic environment. Various sets of modules are used in order to eliminate the memory effect for the participants.

  • Aim: to evaluate the participant’s ability to navigate the hysteroscope.
  • Use forward/backward and rotation movements in order to be able to identify all targets.
  • The objective is to visualize the reach of all area’s of the uterine cavity.
  • Camera handling with a 30° optic.
  • Camera head in non-dominant hand.
  • Rotate with dominant hand for correct view.
  • The screen is equipped with a transparent with circle in the middle.
  • Now, have a closer look at the video.

EXERCISE 2: Hand-eye coordination

Evaluates the skills of simultaneous camera and instrument handling and hand-eye coordination skills. Demands from the mentee to pick and extract 14 pin objects out of the HYSTT model.

  • Aim: To evaluate the participants ability to handle a hysteroscopic forceps, grasp an object and transport it.
  • Place the optic as such that you have an overview of the cavity.
  • The assistant starts the stopwatch and informs the mentee to start the exercise.
  • The mentee has to identify and remove in a predifined sequence 14 coloured pins.
  • Press stop when the last pin is placed.
  • The maximal time of the test is 180 sec.
  • The exercise is performed 3 times by every participant.
  • Now, have a closer look at the video.


HYSTT 2: MIGS level

EX 1: Same principle as HYSTT1 Exercise 1 but with measurement of additional parameters (camera error and light cable error).

EX 2: The vagina is directly connected with the HYSTT model (no cervical dimension) and the mentee has to identify and remove 12 coloured pins.

  • Mentor names a position (Cornua, Mid or Istmus) and a colour (black, red, blue or yellow) according to the sequence on the scoring sheet
  • Mentee locates the pin and positions the instruments to take the pin out
  • Mentor verifies the position, colour and camera
  • Mentor says OK or NOT OK, the mentor does not give any additional feedback and the mentee can only continue once the errors have been corrected.