Use of the Modified Beef Tongue Model for Teaching Repair of Obstetrical Fourth-Degree Laceration to Residents
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/15/2017 |
| Start Date: | November 14, 2017 |
| End Date: | June 2018 |
| Contact: | Joseph Malek, MD |
| Email: | jmalek@uabmc.edu |
| Phone: | 205-996-5466 |
Use of the Modified Beef Tongue Model for Teaching Repair of Obstetrical
This is a study evaluating the use of the modified beef tongue model for teaching repair of
obstetrical fourth-degree laceration to residents. Participants will be randomized to either
an instructional video using the modified beef tongue model or to an instructional workshop
using the modified beef tongue model. Primary outcome will be measured as change in technical
skills score as measured by change from baseline on a validated objective structured
assessment of technical skills (OSTATS) for repair of fourth-degree laceration.
obstetrical fourth-degree laceration to residents. Participants will be randomized to either
an instructional video using the modified beef tongue model or to an instructional workshop
using the modified beef tongue model. Primary outcome will be measured as change in technical
skills score as measured by change from baseline on a validated objective structured
assessment of technical skills (OSTATS) for repair of fourth-degree laceration.
Institutional Review Board approval has been obtained and written informed consent will be
obtained prior to initiation of the study. All obstetrics and gynecology residents at the
University of Alabama will be eligible for the study.
Eligible residents who desire will be enrolled and consented for the trial. Participants will
then complete a short pre-intervention knowledge assessment written test and be asked to rate
their confidence level in completing a fourth-degree repair based on a Likert scale. The
written test is the same as the one used by Patel et al to evaluate residents' knowledge
about fourth-degree laceration repair. The questions are based on Williams's obstetric
chapter on episiotomy repair and showed construct validity given a significant difference in
scores between postgraduate year (PGY)-1 and PGY-4 residents. Participants will also complete
a baseline objective structured assessment of technical skills (OSATS) assessment for repair
of fourth-degree obstetric laceration on a commercial anatomical replica, the Sultan Anal
Sphincter Trainer (Limbs & Things Inc, Savannah, Georgia). This model comes with a
replaceable perineal pad that allows approximately 24 repairs before replacement is
necessary. The validated OSATS used will be the assessment described by Siddiqui et al and
validated on a surgical model. The repair will be videotaped and then distributed to
evaluators who will use the 20 item task specific checklist described by Siddiqui et al. The
time taken for the repair will be recorded.
Demographic and baseline data will be collected on the participants including PGY level,
number of fourth-degree lacerations performed, whether they have read a textbook regarding
fourth-degree laceration repair, whether they have read a journal article regarding
fourth-degree laceration repair, whether they have attended a didactic session in pelvic
anatomy, and whether they have attended a didactic session on fourth-degree laceration
repair.
Participants will then be randomized into two groups. Randomization will be performed using a
computer-generated block design so that each group has a balanced number of residents in each
postgraduate year training level. One group will be randomized to the modified beef tongue
video and one will be randomized to the modified beef tongue instructional workshop. The
modified beef tongue video group will be given an instructional video created using the
modified beef tongue model to show anatomy and proper repair of the laceration. The group
randomized to the modified beef tongue instructional workshop will undergo an interactive
workshop using the modified beef tongue model to show anatomy and proper repair of the
laceration.
The modified beef tongue for the video and workshop will be prepared according to the model
previously described in the literature. The modified model includes beef tripe (small
intestine) used for anal mucosa and chicken leg muscles for anal sphincter muscle analogs.
The tripe is tunneled through the body of the trimmed beef tongue and sutured like an ostomy
to simulate the anal canal. The tongue is incised toward the tripe "anal canal." Chicken leg
muscles are tunneled from the incision out to the cut edges of the beef tongue to create anal
sphincter muscle analogs.
Following the didactic intervention, participants from each group will be given the written
knowledge assessment test again and the objective structured assessment of technical skills
(OSATS) for repair of fourth-degree laceration on the commercial anatomical replica again.
The time taken for the repair will be recorded. Residents will also be asked to evaluate
model realism, ease of use, and satisfaction using a Likert scale. The residents will be
asked to assess their confidence again using a Likert scale.
The participants will then be crossed over and those who were initially randomized to the
video group will then undergo the instructional workshop and the ones initially in the
workshop group will be given the instructional video. Participants will then be asked to rate
their overall preference between models on a scale of 1 to 10 with 1 being the video and 10
being the instructional workshop. They will also complete the written knowledge test again.
The results of this trial may help to inform to a cost- and time-efficient manner of
instruction on the repair of 3rd and 4th degree lacerations. A weakness is that it is unclear
whether this will translate to effectiveness at the time of an actual third- and
fourth-degree repair.
obtained prior to initiation of the study. All obstetrics and gynecology residents at the
University of Alabama will be eligible for the study.
Eligible residents who desire will be enrolled and consented for the trial. Participants will
then complete a short pre-intervention knowledge assessment written test and be asked to rate
their confidence level in completing a fourth-degree repair based on a Likert scale. The
written test is the same as the one used by Patel et al to evaluate residents' knowledge
about fourth-degree laceration repair. The questions are based on Williams's obstetric
chapter on episiotomy repair and showed construct validity given a significant difference in
scores between postgraduate year (PGY)-1 and PGY-4 residents. Participants will also complete
a baseline objective structured assessment of technical skills (OSATS) assessment for repair
of fourth-degree obstetric laceration on a commercial anatomical replica, the Sultan Anal
Sphincter Trainer (Limbs & Things Inc, Savannah, Georgia). This model comes with a
replaceable perineal pad that allows approximately 24 repairs before replacement is
necessary. The validated OSATS used will be the assessment described by Siddiqui et al and
validated on a surgical model. The repair will be videotaped and then distributed to
evaluators who will use the 20 item task specific checklist described by Siddiqui et al. The
time taken for the repair will be recorded.
Demographic and baseline data will be collected on the participants including PGY level,
number of fourth-degree lacerations performed, whether they have read a textbook regarding
fourth-degree laceration repair, whether they have read a journal article regarding
fourth-degree laceration repair, whether they have attended a didactic session in pelvic
anatomy, and whether they have attended a didactic session on fourth-degree laceration
repair.
Participants will then be randomized into two groups. Randomization will be performed using a
computer-generated block design so that each group has a balanced number of residents in each
postgraduate year training level. One group will be randomized to the modified beef tongue
video and one will be randomized to the modified beef tongue instructional workshop. The
modified beef tongue video group will be given an instructional video created using the
modified beef tongue model to show anatomy and proper repair of the laceration. The group
randomized to the modified beef tongue instructional workshop will undergo an interactive
workshop using the modified beef tongue model to show anatomy and proper repair of the
laceration.
The modified beef tongue for the video and workshop will be prepared according to the model
previously described in the literature. The modified model includes beef tripe (small
intestine) used for anal mucosa and chicken leg muscles for anal sphincter muscle analogs.
The tripe is tunneled through the body of the trimmed beef tongue and sutured like an ostomy
to simulate the anal canal. The tongue is incised toward the tripe "anal canal." Chicken leg
muscles are tunneled from the incision out to the cut edges of the beef tongue to create anal
sphincter muscle analogs.
Following the didactic intervention, participants from each group will be given the written
knowledge assessment test again and the objective structured assessment of technical skills
(OSATS) for repair of fourth-degree laceration on the commercial anatomical replica again.
The time taken for the repair will be recorded. Residents will also be asked to evaluate
model realism, ease of use, and satisfaction using a Likert scale. The residents will be
asked to assess their confidence again using a Likert scale.
The participants will then be crossed over and those who were initially randomized to the
video group will then undergo the instructional workshop and the ones initially in the
workshop group will be given the instructional video. Participants will then be asked to rate
their overall preference between models on a scale of 1 to 10 with 1 being the video and 10
being the instructional workshop. They will also complete the written knowledge test again.
The results of this trial may help to inform to a cost- and time-efficient manner of
instruction on the repair of 3rd and 4th degree lacerations. A weakness is that it is unclear
whether this will translate to effectiveness at the time of an actual third- and
fourth-degree repair.
Inclusion Criteria:
- Residents currently in training program at University of Alabama at Birmingham
Exclusion Criteria:
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