Resident competency in obstetric anal sphincter laceration repair.
OBJECTIVE
To estimate objectively the proficiency of obstetrican-gynecologist (ob-gyn) residents in third-degree perineal tear repair.


METHODS
A total of 40 ob-gyn residents from 13 residency programs demonstrated their technique of perineal laceration repair on a modified beef tongue model. Two faculty members with expertise in repairing obstetric anal sphincter injury evaluated the residents using a checklist. The checklist identified three key steps of the procedure, including 1) repair of the internal anal sphincter; 2) selection of proper suture material; and 3) repair of the external anal sphincter, further evaluated using three subcomponents.


RESULTS
The overall pass rate was 42.5% (17/40). Many residents missed critical steps of the repair. Year of training (P=.763), parent residency program (P=.5), and prior experience (P=.48) had no significant effect on the pass rate. There was greater than 90% concordance between the evaluators (r=0.9, P<.001). Satisfaction with the modified beef tongue model was higher than with current training methods in their program (7.81 compared with 6.92 on a scale of 1-10, P=.001).


CONCLUSIONS
Ob-gyn residents demonstrated substandard skill in repairing anal sphincter laceration. The low pass rate of 42.5% suggests lack of adequate training in repair. The model had a high resident satisfaction, and high interobserver correlation was noted using the checklist. Thus, identification and evaluation of key steps using a standardized checklist may lead to standardization of repair and ensures consistency and quality.


METHODS
III.
Uppal
Shitanshu
S
From the Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, Bay State Medical Center, Springfield, Massachusetts; Temple University School of Medicine, Philadelphia, Pennsylvania; and the Institute for Clinical Simulation and Patient Safety, Temple University, Philadelphia, Pennsylvania.
Harmanli
Oz
O
Rowland
Jennifer
J
Hernandez
Enrique
E
Dandolu
Vani
V
D001003:Anal Canal / Q000293:injuries / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D007744:Obstetric Labor Complications / Q000601:surgery*; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D013664:Teaching Materials