Residents’ experience and training in obstetric anal sphincter injury repair in the United States

Abstract

With the reduction in obstetric anal sphincter injuries (OASIS) cases, it is unknown if learning and exposure to their repair is compromised during obstetrics and gynecology (OBGYN) residency in the United States (US). The aim of this study was to evaluate the exposure and confidence level of the US OBGYN residents to OASIS repair. Residents’ education on OASIS repair was also assessed. This was a cross sectional online survey that collected residents’ demographics, characteristics of residency program, the number of deliveries and OASIS repairs performed, the site and technique of OASIS repair, post-repair care provided, residents’ confidence level in OASIS repair and their education on the repair. Descriptive analyses, Fisher’s Exact tests, Ordinal regression models and Spearman’s correlation were performed. Response from 160 residents (11% response rate) was obtained. Confidence was higher with increasing level of training (OR = 3.442, 95% CI, 2.473-4.791, p<0.004), a greater number of deliveries (OR=2.672, 95% CI, 1.511-4.723, p<0.001), third-degree repairs (OR=5.522, 95%CI, 3.67-8.308, p<0.001) and fourth-degree repairs (OR=4.364, 95% CI, 2.785-6.837, p<0.001) performed. Exposure to lecture or/and simulation improved confidence than no exposure to either (OR= 0.225, 95% CI, 0.092-0.545, p<0.001). Residents’ confidence level increased with a greater number of simulations attended (r=0.368, p< 0.001). Lectures and simulations enhance residents’ knowledge and skills in OASIS repair. Surgical skill curriculum is essential to maintain good quality training, prompt recognition, and meticulous perineal repair among OBGYN physicians despite the declining OASIS cases.