Lithotomy and Sitting Positioning: An Objective Structured Clinical Examination

A foundational skill for anesthesia providers is the ability to safely position surgical patients in a wide variety of surgical positions. Two commonly used surgical positions are the lithotomy and sitting positions. These positions have potential complications that include loss of control of the airway, accidental removal of invasive lines, physiological derangements, soft tissue injury, and nerve injury (Barash et al., 2017). Chui et al. (2018) identified that peripheral nerve injury accounted for 12% of closed claims relating to procedures done under general anesthesia and the most common identifiable event is positioning. The median payout for a peripheral nerve injury claim was calculated to be $80,250 (Chui et al., 2018). Due to how commonly these positions are used, with the potential physiological and financial complications, it is imperative that anesthesia providers receive extensive training in the positioning of surgical patients. Objective Structured Clinical Examination (OSCE) is a common education tool that is used to teach and empirically test students in clinical simulation scenarios. The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP) did not have OSCEs developed for the lithotomy and sitting position as part of its curriculum. Therefore, the goal of this DNP project was the development of OSCEs for each of these positions from current evidence-based literature. A panel of current anesthesia providers, USM NAP faculty, and anesthesia students at USM NAP were surveyed to evaluate the developed OSCEs. The survey data showed that the OSCEs were well received, represented evidence-based doctoral-level work, addressed potential complications of each position, and would improve learner confidence.