Procedural proficiency in the placement of a word catheter: a resident training model

Abstract

Study objectives: Residency involves on-the-job training and may present a risk when the least-experienced personnel perform critical procedures requiring a degree of surgical skill and dexterity. We develop a training tool for the evaluation and treatment of a Bartholin's cyst or abscess. We assess resident procedural proficiency in the placement of a Word catheter. Methods: This was a prospective before-and-after model. Postmortem porcine tissue was fashioned to simulate the female perineum with Bartholin cyst or abscess. A Foley catheter placed at the vestibule was inflated with Maalox to simulate a Bartholin cyst or abscess. Residents completed a survey to validate the model's clinical fidelity. With an array of equipment used in treatment, including a Word catheter, residents were asked to treat this model as they would a patient. Each resident was individually and critically evaluated and scored using a standardized critical points sheet for procedural competence before and after viewing an instructional video on the placement of a Word catheter. Results: Equal numbers of obstetrics and gynecology (OBGYN) and emergency medicine residents participated (N=34). Sixty-eight percent stated that the model resembled female genitalia. Sixty-one percent correctly diagnosed a Bartholin cyst or abscess. Emergency medicine residents' responses were comparable to those of the OBGYN residents. Mean pretraining score was 5.5±1.46 (range 3 to 9). Mean posttraining score was 8.2±1.20 (range 4 to 9 points). There was a 58% increase in procedural proficiency (<i>P</i><.05). Conclusion: A model female perineum fashioned from porcine tissue can be used to instruct residents in the recognition of a Bartholin cyst or abscess. Residents' procedural proficiency in the placement of a Word catheter may be improved through the use of tissue model perineum and instructional video.