Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice

Abstract

We conducted an audit to evaluate how effective a structured course in the management of obstetric anal sphincter injuries (OASIS) was at imparting knowledge. Training was undertaken using models and cadaveric pig's anal sphincters. An anonymous questionnaire was completed prior to and 8 weeks after the course. Four hundred and ninety seven completed the questionnaire before and 63% returned it after the course. Prior to the course, participants performed on average 14 OASIS repairs independently. Only 13% were satisfied with their level of experience prior to performing their first unsupervised repair. After the course, participants classified OASIS more accurately and changed to evidence-based practice. Particularly, there was a change in identifying (60% vs. 90%; P < 0.0001) and repairing the internal sphincter (60% vs. 90%; P < 0.0001). This audit demonstrated that training in the management of OASIS is suboptimal. Structured training may be effective in changing clinical practice and should be an adjunct to surgical training.