A Simple Pessary Insertion Model for Resident Simulation

INTRODUCTION: Vaginal pessaries are widely used by gynecologists as conservative management of pelvic organ prolapse. They are useful in patients who are not good surgical candidates or who decline surgical intervention. Studies have shown that up to 92% of women can successfully be fitted with a pessary, although this success is highly dependent on provider comfort and knowledge in pessary placement. The CREOG learning objectives state that understanding and performing pessary fitting is a core procedure OB/GYN residents should be comfortable performing by graduation. However, a study of OB/GYN residents reported that less than 50% of residents felt their program adequately prepared them to fit pessaries. Despite the evidence that residents feel uncomfortable fitting pessaries, there is limited data on methods to improve education and comfort in pessary use. OBJECTIVE: The objective of this video is to describe the design of a simple, low-cost pessary insertion model for resident simulation training. METHODS: The following supplies were used for creating the vaginal model: Two cardboard boxes, 1 foam can cooler, 1 24-inch Latex balloon, 1 large silicone baking mold, duct tape, 1 12 ×10×1-inch wood board, two hook screws, small bolts, washers, and nuts, table clamps, 1 elastic band, and 1 shoe-lace or string. Most of the items can be found online or at any local arts and crafts store. Total cost of a single model is about $20, although cost is lower if multiple models are created due to shared supplies. RESULTS: In this video, we present a design for a vaginal model for teaching pessary insertion and removal to OB/GYN residents. While rates of successful pessary insertion can be high in selected patients, they may be dependent on provider knowledge and comfort with pessaries and their use. Studies show that less than half of OB/GYN residents may feel adequately prepared to fit pessaries. There is limited data on specific methods to improve resident education and comfort with pessary use. We demonstrate step-by-step instructions on how to construct the model using materials found at most arts and crafts stores, for a total cost of about $20 per model. The design incorporates the use of a large 24-inch latex balloon and large silicone mold, which may be customized to different-sized genital hiatuses. Simulation tasks may include: selecting appropriate pessary, insertion of pessary, checking position, and removal of pessary. This simulation model may be combined with didactic sessions to help increase resident knowledge, skill, and comfort with pessary use. CONCLUSIONS: We present a simple vaginal model that provides simulation of vaginal pessary insertion for OB/GYN residents. Benefits of this model include low cost, simple design, options to customize genital hiatus size, reusability, and compatibility with any pessary type. This model also allows for assessment of resident skill and pessary insertion and removal technique. The model presents an opportunity for an an accessible and affordable way to augment a residency program’s curriculum regarding pessary simulation and teaching.