Purpose: To create a realistic, high-fidelity, low-cost, reproducible simulation curriculum for 3rd and 4th degree perineal laceration repairs.
Background: Third- and fourth-degree perineal lacerations complicate up to 4% of vaginal deliveries and can result in long-term morbidity including fecal incontinence and rectovaginal fistula formation. These are uncommon but important complications that all obstetrics and gynecology residents must be able to recognize and appropriately repair. The commonly-used beef tongue model is not readily obtainable and requires significant clean-up that may pose logistic issues in administrative spaces.
Methods: We created a realistic, easily reproducible model of the perineum including all critical layers of tissue to be repaired in the case of 3rd or 4th degree laceration, improving upon an existing model. Materials included candy bar, condom, felt fabric, steak strips, sponge, 2-0 and 3-0 Vicryl suture, 2 Alice clamps, 4 Kelly clamps, forceps, needle driver, suture scissor, and baking sheet. Total estimated cost is $5.40 per model. Residents participated in a 2.5 hour simulation session including half hour lecture and 2 hour hands-on simulation activity in groups of 3-4 participants. A questionnaire was administered after activity completion.
Results: Our model improved upon a prior model with a felt pocket (internal anal sphincter) that provides more stability (less slippage) of the rectal mucosa and rectal contents during repair, includes the second degree component (sponge taped to the felt), and uses beef strips rather than preserved meat to similate the external sphincter, which is less brittle and more realistic. 7/15 participants (46.7%) responded to the after-activity questionnaire, consisting of one PGY1, three PGY2s, two PGY3s, and one PGY4. One hundred percent strongly agreed or agreed that the scenario was realistic, and 100% strongly agreed or agreed that the activity enhanced learning of the topic and better equipped them to manage 3rd and 4th degree lacerations after vaginal delivery.
Discussions: We present a realistic, low-cost, and easily reproducible learning tool to teach residents the critical anatomy and fundamental principles underlying repair of 3rd and 4th degree perineal lacerations. The model improved upon existing models and increased participant knowledge and comfort with repair of obstetric anal sphincter injuries.
Topics: CREOG & APGO Annual Meeting, 2022, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Simulation, General Ob-Gyn,
Gregory W. Kirschen, MD PhD, The Johns Hopkins Hospital; Katerina Hoyt, MD; Chi Chiung Grace Chen, MD, MSH; Golsa Yazdy, MD
