Ob/Gyn Resident Surgical Simulation Education Curriculum (SERP)

You have two to three years to develop the basic surgical technical skills that will stay with you forever. The goal is to practice the right way every time and to practice the same way every time. By doing this, you'll develop the muscle memory that will allow you to operate efficiently, precisely and proficiently. Stated another way, you want to make the transition from unconscious incompetence----to conscious incompetence----to conscious competence----to unconscious competence. Research has shown that repetitive practice of technical skills and simulation of virtually every aspect of procedural and technical skills improves performance.

The SERP program is run in 3 environments. Self-directed learning occurs wherever and whenever you have time to practice. The directed dry labs are scheduled in the ISIS center and use models, simulators, skills drills, etc. for training and evaluation. Self-directed practice in ISIS is also possible. The Pig Labs use the live porcine model to allow the training and evaluation of several OB/GYN procedures during one lab. During the 4 years of training you will reach the following objectives.

General SERP Program Objectives

Objective 1:

  • Increase efficiency, procedural precision and attain proficiency for OB/GYN procedures by providing the opportunity to repetitively practice specific skills & procedures

Objective 2:

  • Simulate for the purpose of training and testing students, residents and faculty the common emergencies seen in the labor and delivery unit

Objective 3:

  • Simulate for the purpose of training and testing students, residents and faculty the essential procedures for generalist Obstetrician Gynecologist

Objective 4:

  • Study simulations, simulators and the circumstances surrounding their application for the purpose of improving student, resident and faculty training as well as verification of surgical and emergency skills

Objective 5:

  • Implement, through scenario simulation, the principles and culture of teamwork using the TEAM STEPPS model

General Surgical Skills

Suture and Needle Selection (R1, R2)

  1. Identify and characterize resorbable and permanent sutures and describe the advantages and disadvantages of each
  2. Know the relative tensile strength of various sutures
  3. Know the numbering of suture material based on diameter of the fiber
  4. Know the optimal suture material for selected clinical situations

Knot tying (R1, R2)

  1. Tie a two-handed square knot
  2. Tie a two-handed surgeon's knot
  3. Tie a one-handed square knot
  4. Tie a one-handed surgeon's knot
  5. Tie a square knot and surgeon's knot using an instrument tie
  6. Tie a square knot in a deep space
  7. Tie a knot on a passer (Right and Left)

Knowledge of surgical instruments, their selection and use (R1, R2)

  1. Know the names of the surgical instruments most commonly used in OB/GYN surgery and principal uses for each
  2. Know the proper technique for manipulating each instrument

Suturing (R1, R2)

  1. Know the anatomic landmarks for a subumbilical midline incision and transverse (Pfannenstiel) incision
  2. Know the advantages and disadvantages of a subumbilical midline incision and a transverse incision
  3. Know the optimal incision for selected clinical situations
  4. Perform the following closures: simple interrupted sutures, continuous suture, and Smead-Jones suture

Energy Sources (R3)

  1. Know the different types of energy sources and appropriate power settings for the electrosurgical unit
  2. Know the advantages/disadvantages of bipolar cautery versus monopolar cautery
  3. Know the distinction between "tissue cutting" and "tissue coagulation"
  4. Know the electrical waveform for cutting current versus coagulation current versus blended cutting current
  5. Describe the role of the return electrode pad
  6. Characterize the adjacent tissue injury with the different electrical currents
  7. Know the differences between Gyrus, Ligasure, and Harmonic technology

Obstetrics Teaching Objectives

Episiotomy trainer (R1, R2 1st & 2nd degree; R4 3rd & 4th degree)

  1. Know the degrees of injury to the perineum, rectum and external anal sphincter
  2. Repair a simulated midline episiotomy of any degree

Shoulder Dystocia

  1. Identify a shoulder dystocia, and recognize a need for further assistance (R1, R2)
  2. Ask team members for appropriate assistance (R1, R2)
  3. Perform the maneuvers to reduce the shoulder dystocia (McRobert's, suprapubic pressure, Posterior arm, Wood's screw/Rubin's rotation, Episiotomy, Position change) (R2-R4)
  4. Correctly document the procedure (R2-R4)

Operative Vaginal Delivery with Forceps and Vacuum (R3/R4)

  1. Identify need for intervention with forceps or vacuum
  2. Appropriately counsel patient regarding indication, risks, benefits
  3. Correctly place forceps or vacuum
  4. Perform the maneuvers correctly
  5. Correctly document the procedure.

Hypertensive Emergencies (R2-4)

  1. Recognize risk factors for hypertensive disorders
  2. Recognize preeclampsia (mild and severe), HELLP syndrome, and eclampsia
  3. Know of the major threats to maternal and fetal life
  4. Properly manage Preeclampsia, HELLP and/or eclamptic seizure
  5. Recognize and properly manage complications from the management of hypertensive disorders
  6. Recognize magnesium toxicity
  7. Properly manage of magnesium toxicity

Obstetric Hemorrhage (R2-4)

  1. Know the etiologies of ante-, intra and post-partum hemorrhage
  2. Correctly recognize hemorrhage
  3. Acquire an appropriate history
  4. Correctly diagnose the likely etiology
  5. Properly examine the patient to confirm the likely diagnosis
  6. Properly manage placental abruption
  7. Properly manage bleeding previa
  8. Properly manage uterine rupture
  9. Perform manual and surgical evacuation of retained products
  10. Properly manage uterine atony
  11. Properly repair a laceration of the cervix
  12. Properly manage persistent bleeding refractory to the first line therapy