Episiotomy and perineal repair. An evaluation of resident education and experience

OBJECTIVE: To describe current training practices and experience with episiotomy and perineal repair in obstetrics and gynecology residency programs in the United States. STUDY DESIGN: A questionnaire mailed to all directors of accredited programs in the United States for distribution to fourth-year residents in their last four months of training included 30 questions regarding formal teaching, supervision, experience and repair techniques. RESULTS: A total of 297 of 1,177 (25.2%) residents, representing 47% of programs, responded. The response rates for the various program sizes were: 32.0% for < or = 12 residents, 29.5% for 13-19 residents, 24.6% for 20-24 residents and 18% for > or = 25 residents. Of the residents, 59.9% received no didactics on episiotomy repair techniques; 59.3% had no formal teaching on pelvic floor anatomy; and 27.7% of third-degree repairs were supervised by attending physicians. Of the respondents, 6.8% had repaired > 20 fourth-degree lacerations and 40.3%, > 20 third-degree lacerations. Ten percent of the graduates felt inadequately trained in perineal repair. CONCLUSION: This survey of fourth-year residents from 47% of obstetric programs indicated that the majority of residents received no formal training in pelvic floor anatomy, episiotomy or perineal repair and, when engaged in such activities, had limited supervision.