Journal of Surgical Simulation 2022; 9: 74 - 82

Published: 04 August 2022


Original article

Challenges in evaluation of a simulation-based educational course for repair of obstetric anal sphincter injuries

Bidyut Kumar and Ruth Roberts
Corresponding author: Bidyut Kumar, Wrexham Maelor Hospital, Croesnewydd Road, Betsi Cadwaladr University Health Board, North Wales, LL13 7TD, UK. Email:


Background: Failure to identify and repair anal sphincter injuries sustained during childbirth can lead to significant long-term morbidity. This paper describes the evaluation methods used to assess the efficacy of The All Wales Hands-on Third and Fourth Degree Perineal Tear Repair Course in reducing the long-term complications associated with obstetric anal sphincter injuries (OASIS).

Methods: Formative evaluation was received from the learners between 2015 and 2021. The post-surgical outcome after OASIS repair in North East Wales was assessed using a postal questionnaire sent to general practitioners between 2012 and 2015. The survey was done 1 year after the last case of OASIS in 2015.

Results: Feedback from all the learner delegates suggested a high satisfaction rate. Forty-five women were identified as needing repair of OASIS giving an OASIS incidence of only 0.6%. Of the 45 questionnaires, 35 (77.8%) were returned by the general practitioners. None of the 35 women had reported any residual symptoms of anal incontinence to their general practitioner.

Conclusion: This review demonstrates high post-course satisfaction rates among attending delegates and very low reported long-term complication rates after OASIS repair in women giving birth in North Wales. The simulation-based education described appears highly effective in reducing the long-term complications associated with obstetric anal sphincter injuries, suggesting that the skills developed in the laboratory are being transferred to the real-life setting. However, designing a strategy to adequately evaluate a course of this nature is difficult and needs careful planning to overcome the challenges posed by this type of research.


obstetric anal sphincter injury; simulation-based education; evaluation of simulation-based education course