Using a structured assessment of technical skills checklist for surgical management of postpartum hemorrhage

BACKGROUND: Maternal hemorrhage during cesarean sections can often beidentified and managed surgically with use of the B-Lynch compression suture, andO’Leary (bilateral uterine artery ligation) stitch. Residents may improve their performanceof these procedures using a technical skills checklist with global rating scale.OBJECTIVE: To assess the reliability and validity of a technical skills checklist forthe B-Lynch Suture and O’Leary Stitch using a surgical model.METHODS: Two blinded evaluators reviewed the recordings of 52 obstetrics/gynecology residents and 25 attending physicians performing the simulated BLynchand O’Leary Stitch using a felt uterus model from March 1 2017 to August 31,2017. The evaluators completed task-specific OSATS and global rating scales (GRS)for the two simulations. Interrater reliability and construct validity were assessed.RESULTS: Interrater reliability was 97% for task-specific OSATS (task specificchecklist, TSC) and exceeded 98% for GRS. For construct validity regarding B-Lynchsimulation, attending physicians and senior residents scored higher than junior andnew residents; TSC (15.04 and 15.12, respectively vs. 5.63 and 3.38); GRS B-Lynch(22.38 and 19.35, respectively vs. 8.85 and 6.75. For the O’ Leary simulation, seniorresidents and attending physicians scored higher than junior and new resident on TSC(15.20 and 13.65, respectively, vs. 11.54 and 2.83). Similar findings noted for O’LearyGRS (23.76 and 21.32 vs. 14.89 and 6.83).CONCLUSION: There was good interrater reliability and construct validity using atask-specific OSATS for B-Lynch and O’Leary Stitch. This instrument shows promiseas a tool for competency-based evaluations.Key words: Assessment of skills for postpartum hemorrhage