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Improving the Evaluation and Management of Bladder Injury in Gynecologic Surgery with Cadaver Surgical Skills Curriculum

Purpose: The purpose of this study was to implement a comprehensive cadaver and simulation skills training curriculum in cystotomy repair for OBGYN residents.

Urologic injuries are a major complication of gynecologic surgery, occurring in 0.18-0.80% of procedures and most commonly involving the bladder.  Appropriate identification, evaluation, treatment, repair, and follow-up by gynecologic surgeons are important to reduce the long-term morbidities associated with bladder injuries.

Methods: This was a prospective observational study with pre/post cohort design including 10 OBGYN residents (PGY1-3) at Inova Fairfax Hospital. The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: knowledge, confidence, and technical skills.  The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the cystotomy curriculum. Similarly, knowledge and confidence were evaluated with pre- and post-surveys.

Results: Across all three PGY levels, statistically significant improvements were observed in knowledge, confidence, and global skills after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents’ ability to describe and perform cystotomy repairs. Additionally, residents consistently showed high satisfaction with the cystotomy curriculum.

Educating and training OBGYN residents to manage and repair cystotomies can be challenging with the low incidence of injury. The cadaver surgical skills curriculum was an effective training module. The cadaver lab remains an important component of skills training in conjunction with simulation and traditional didactic sessions.

Topics: CREOG & APGO Annual Meeting, 2021, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Quality & Safety,

General Information

Student,Resident,Faculty,Residency Director,Residency Coordinator,
Patient Care,Medical Knowledge,Practice-Based Learning & Improvement,
Simulation,Quality & Safety,
Clinical Focus

Author Information

Cassandra Presti, MD, INOVA Fairfax Hospital; Conway Xu, MD; Larry Walker; Lauren Scott, MD; S. Abbas Shobeiri, MD; Francine McLeod, MD

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