Low-Budget Perineal Repair Model on Modular Base
Authors: Schmitt Eric , Roble Jose , Penick Emily , Humes Jamie 
Published: June 2024

OBJECTIVE:
The American College of Obstetricians and Gynecologists reports that 53–79% of patients will sustain some type of perineal laceration during vaginal delivery. Although many simulations already are designed to practice these repairs, we have found that formal reusable anatomic models often are accessible only in simulation rooms. Self-built designs, such as the beef tongue model, are useful for a simulation day but require disposal after one use. We designed a $5.16 foam model that can be used to practice all types of perineal repairs. Our model can be used with an already-described modular base, which has been used to practice vaginal morcellation as well as loop electrosurgical excision procedures.

PROJECT SUMMARY:
We developed a written guide with visual aids describing how to build both our model and the base. All of the materials are available at local home improvement retailers. A basic description of the steps includes:Cut two 6-inch and one 4-inch segment of pipe-insulator. Cut a single 5-inch segment of foam tape. Use double-sided tape to cover the top and bottom lips of the 6-inch pipe insulator.Pull off adhesive strips and form a circle with one 6-inch segment of pipe insulator.Nest this segment of insulator inside the other 6-inch segment and attach with tape. This represents the vaginal walls.Use scissors to make a hole near the taped lip of the insulator and feed the foam tape through this hole. This represents the external anal sphincter. The pipe insulator below the foam tape represents the internal anal sphincter.Use tape to attach a glove finger to the bottom of the model. This represents the rectum.Cover this with the final layer of 4-inch foam. You are ready to practice with your model.

OUTCOMES:
Thirty health care professionals built and used the model, then participated in an anonymous survey. Survey respondents included two medical students, 13 residents, four midwives, and 11 obstetrics and gynecology staff. Participants found the model to be a very or somewhat realistic simulation of a second-, third-, and fourth-degree repair (26/30, 21/24, and 17/23 respondents, respectively). Participants also found that the model either greatly or somewhat contributed to their confidence in performing a second-, third-, or fourth-degree repair (23/30, 19/30, and 17/30 respondents, respectively). Twenty-four respondents (80%) found this simulation to be a useful addition to their routine training, and 22 found the model very easy or somewhat easy to build.

RELEVANCE:
Our model is an effective and economical tool for practicing perineal repairs. The design features improvements in accessibility of materials and in the ease of assembly. In a cost-comparison analysis, our model cost $5.16 per model compared with $16.50 per beef tongue model and $325 per mannequin multi-use model. It takes 10 minutes to build compared with 30 minutes for the beef tongue model. With only simple adjustments, the model is adaptable to practice complex and simple perineal lacerations. The range of options allows for customization of the model to the appropriate level of the learner. Our model supports learners of all levels of experience, is affordable, is adaptable, has proven effectiveness, and can be adapted to any environment.