IntroductionFourth-degree lacerations are infrequent but serious complications that involve the tearing of the vaginal epithelium, tissues of the perineal body, anal sphincter complex, and the rectal mucosa at the time of vaginal delivery.1 Prior studies 2 have shown a high incidence (up to 60%) of perineal pain, anal incontinence, and dyspareunia after severe perineal injury during childbirth. Perineal lacerations after childbirth are classified as first-, second-, third-, and fourth-degree on the basis of the tissues involved; third-and fourth-degree are considered serious because the external anal sphincter is involved in the laceration. Unfortunately, residents are universally undertrained in the repair of fourth-degree lacerations because of their infrequency. However, it is vital that graduating residents be able to repair a fourth-degree laceration even if they did not encounter one during their training. Prior research has demonstrated that the combination of the Objective Structured Assessment of Technical Skills (OSATS) and a written examination before and after an educational workshop is a valid and reliable way of assessing residents' improvement in surgical skills and knowledge in the repair of fourth-degree lacerations.
4,5We sought to expand this work by including a 6-month follow-up OSATS and written examination to evaluate the retention of information learned during the workshop. We hypothesized that residents' technical skills and knowledge to repair fourth-degree perineal lacerations will reflect
AbstractBackground Fourth-degree perineal lacerations are a serious but infrequent complication of childbirth.