Low fidelity model for sacrospinous ligament fixation for resident education

The American College of Obstetrics and Gynecology (ACOG) has emphasized that curriculum-based simulation should be utilized in resident education. These simulations give learners a realistic hands-on learning approach. Currently, sacrospinous ligament fixation (SSLF) models are not readily available and are unrealistic. The purpose of the study was to implement a SSLF simulation for Obstetric and Gynecology (OBGYN) residents and create an low fidelity SSLF model that was more realistic in replicating the narrow surgical space and required proper dissection(IRB exempt). The model was created using a bony pelvis, a vagina made from silicone and cornstarch, ligaments made from silk tape, and fibrous tissue and membranes using plastic wrap and polyfil (Figure 1). Before instruction, residents completed a pre-test knowledge assessment and SSLF. Residents then received curriculum teaching and SSLF simulation demonstration. Following instruction, residents then performed the post SSLF simulation and the post-knowledge assessment. Simulation skills were assessed using the modified Objective Structures Assessment of Technical Skills (mOSATS). The primary outcome was to compare changes in the mOSATS. The secondary outcome was to compare changes in the pre and post knowledge assessment scores. Thirty residents participated in two simulation sessions over two academic years. The majority had neither seen nor performed a SSLF. For the primary outcome, there was a significant difference in all mOSATS components: instrument handling and movement, suturing time, and proper location and placement on the ligament (Table 1). In addition, it was observed that the model provided challenging surgical simulation due to the narrow surgical space and if the required dissection was not completed properly, sutures were placed incorrectly (Figure 2). For the knowledge assessment, there was a significant improvement in the majority of questions testing anatomy and suture placement, but not for success or complication questions. Our SSLF model can be easily created for SSLF simulation, can be used multiple times, and only costs $82.58 per model. In addition, our study demonstrated an improvement in both mOSATS as well as SSLF knowledge. Given ACOG recommendations for simulation training, OBGYN residency programs should consider creating similar SSLF simulation labs to provide learners better understanding of SSLF surgery as well as proper dissection and suture placement.