Residents' Exposure to Obstetric Anal Sphincter Injury: A 16-Year Temporal Trend

Area of Science:

• Obstetrics and Gynecology
• Surgical Education
• Maternal Health

Background:

• Surgical management of Obstetric Anal Sphincter Injuries (OASIS) is a critical skill for obstetricians.
• Limited exposure to OASIS repair during residency training poses a challenge to developing surgical competence.

Purpose of the Study:

• To quantify resident exposure to OASIS repair during a 4-year Obstetrics and Gynecology (OBGYN) residency.
• To examine temporal trends in OASIS repair exposure over a 16-year period (2007-2022).

Main Methods:

• Retrospective cohort study analyzing OASIS cases (third- or fourth-degree lacerations) during vaginal deliveries.
• Data collected from a community academic hospital from 2007 to 2022.
• Analysis of delivery rates, OBGYN resident numbers, and OASIS repair exposure trends in 4-year epochs.

Main Results:

• Over 103,000 deliveries occurred, with 2,344 (3.4%) OASIS cases (88.5% third-degree, 11.5% fourth-degree).
• The OASIS rate declined from 4.2% to 2.9%, while resident numbers increased by 49%.
• Average resident exposure to OASIS repair decreased from 11 cases (2007-2010) to 5 cases (2019-2022), including less than one fourth-degree repair.

Conclusions:

• Residents experienced an average of 7 OASIS repairs (6 third-degree, 1 fourth-degree) during 4 years of training.
• Insufficient exposure to OASIS surgical management may negatively impact resident competence and patient outcomes.
• Simulation-based training may be necessary to enhance surgeon proficiency in managing OASIS.