Training in obstetric anal sphincter injuries in Australia and New Zealand: A survey of Royal Australian and New Zealand College of Obstetricians and Gynaecologists trainees

Abstract

Background:Training in obstetric anal sphincter injuries (OASIS) in Australia and New Zealand relies upon consultant teaching and has not previously been assessed. Aims:The aims of this study are to establish if training in OASIS is consistent and optimal in Australia and New Zealand and to evaluate trainee perspectives on supervision and teaching, along with confidence in repairing OASIS. Materials and Methods: A descriptive cross-sectional study was performed. Royal Australian and New Zealand College of Obstetricians and Gynaecologists trainees were sent a 21-question survey. The survey was distributed to 725 trainees, and 132 trainees provided complete responses (18.2%). The main outcome measures were (i) comparison of confidence in performing a caesarean section versus OASIS repair and (ii) descriptive analysis of views towards training and suggestions for improvement.Results: Trainees were significantly more confident in performing a caesarean section independently compared to OASIS repair (P < 0.05). This was the case for all year groups. Confidence increased with each year of training. Only 62% reported credentialing at their site. Whereas 50% reported training at the time of first unsupervised repair as good or excellent, 22.7% felt it was suboptimal and 2.3% unsatisfactory; 75.8% had attended a workshop; 38.6% requested mandatory workshops.Requests included that workshops be yearly, include video training and be required at consultant level. Trainees asked for supervision despite credentialing and for separate credentialing for 3A/B-and 3C/4th-degree tears. Conclusions:Trainees have increasing confidence in their ability to independently perform OASIS repairs throughout training. They requested that improvements be made to training and that there be an increase in structured teaching.

Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians

“…The percentage of physicians who had attended training courses in Australia and New Zealand was similar (75.8%) [ 19 ], whereas in the American survey, only 44% had had formal training in obstetric trauma classification and diagnosis [ 20 ]. This shows a huge improvement in training in obstetric tears in the last 20 years in the UK.…”

“…They also found that some technical skills decline in performance over time after the course [ 27 ]. When asked for suggestions for improving training in OASIs, 38.6% of Australian and New Zealand physicians asked for mandatory workshops, with some suggesting that these should be yearly [ 19 ]. We propose that attending a refresher course, every 3 to 5 years, could improve knowledge and confidence in the management of perineal trauma.…”

“…However, it is difficult to know the number of physicians the survey reached, as social media was used to advertise, to calculate a response rate. Compared with other similar surveys, the number of included responses is much higher [ 19 , 20 ]. It has been noted that physician web-based surveys often have a low response [ 32 ].…”

“…Similar surveys in the USA, Australia and New Zealand have also found a need for improved training in the diagnosis and management of obstetric injuries [ 19 – 22 ]. In a national cohort of US obstetricians, 66% of respondents had no formal training in obstetric trauma diagnosis and classification [ 20 ], whereas 75.8% of trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists previously attended an OASI workshop [ 19 ]. However, 86.4% still felt that additional training would be valuable [ 19 ].…”

“…In a national cohort of US obstetricians, 66% of respondents had no formal training in obstetric trauma diagnosis and classification [ 20 ], whereas 75.8% of trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists previously attended an OASI workshop [ 19 ]. However, 86.4% still felt that additional training would be valuable [ 19 ]. Almost all (98%) obstetrics and gynaecology resident physicians in Spain felt that there was a need for a theoretical–practical course on pelvic floor anatomy and the repair of its injuries [ 23 ].…”