Teaching the Retropubic Midurethral Sling Using a Novel Cadaver and Model-Based Approach

Area of Science:

• Urology
• Surgical Education

Background:

• Retropubic midurethral sling (MUS) placement is a common procedure for stress urinary incontinence.
• Resident training in MUS can be challenging due to the need for technical proficiency and anatomical understanding.

Purpose of the Study:

• To evaluate the effectiveness of a model-based teaching program in enhancing resident comfort and skill with retropubic MUS.
• To assess the impact of a single-session, hands-on training on resident preparedness for MUS procedures.

Main Methods:

• A pre- and post-training assessment of residents using self-reported measures (Visual Analog Scale, Likert, open-ended questions) and objective assessments (video-scored trocar passage on a pelvic model using mOSAT and a checklist).
• The training session included a lecture and interactive stations with cadaver pelvis, MUS pelvic model, and cystoscopy model.

Main Results:

• Post-training, residents reported increased comfort with retropubic MUS, relevant anatomy, and trocar passage (p = .01).
• Objective measures showed improvement in model trocar passage, with modified Objective Structured Assessment of Technical Skills (mOSAT) scores rising from 47% to 65% (p = .01).
• Residents expressed greater confidence and preparedness after the session, highlighting the value of hands-on repetition and a supportive learning environment.

Conclusions:

• A short, single-session, hands-on group training program effectively improved resident comfort and skill with retropubic MUS.
• Model-based surgical training is a valuable tool for enhancing resident proficiency in gynecological procedures.