A reusable, low-cost model to improve resident confidence in performance of postpartum tubal ligation

Abstract

Proficiency in postpartum abdominal sterilization is a core objective that residents must acquire during residency as outlined by the Council on Resident Education in Obstetrics and Gynecology. Surgical sterilization remains a popular and effective form of contraception in the United States; however, many women requesting immediate postpartum tubal ligation are unable to have the procedure given institutional barriers and variations in practice. Additionally, increasing use of long-term reversible contraceptives has contributed to declining immediate postpartum sterilization rates, which may ultimately impact an Obstetrics and Gynecology resident’s ability and confidence to perform this procedure. Our goal was to develop a reusable, low-cost model to improve resident familiarity and confidence with postpartum tubal ligation. A 3-dimensional model was developed that represents key anatomic structures encountered during tubal ligation and allows residents to perform all procedure steps. Materials and costs were determined. The model was piloted during scheduled simulation time. Residents evaluated the model’s realism and reported confidence in performing the tubal ligation pre- and post-simulation with a 5-point Likert scale . Four reusable models were created for $21.56 each. All PGY level residents (n=12) successfully performed the procedure with most having performed less than 5 postpartum tubal ligations previously. Resident confidence in performing postpartum tubal ligation improved significantly post-simulation (2.58 vs 3.42/5, p=0.005). Residents strongly agreed that the model replicated the steps (4.83/5), resembled the abdominal wall (4.58/5) and peritoneal cavity (4.73/5), and was similar in difficulty to a live procedure (3.2/5). All residents strongly agreed practicing on this model could improve surgical technique (5/5). This model fills a gap in sterilization simulation and resident training. It is low-cost and easily reproducible, closely resembles the pelvic anatomy, allows for completing the steps of the procedure and can be used for resident education to improve confidence with immediate postpartum sterilization.