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). CONCLUSION: 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.