Introduction and Hypothesis <p>Our aim was to compare residents’ skill for anal sphincter injury repair in a silicone-latex simulation anal sphincter injury model after video demonstration, simulation-based training, and a combination of both.</p> Methods <p>We randomized obstetrics and gynecology residents to video demonstration by an expert (group 1), simulation-based training (group 2) and a combination training model (group 3) using a validated silicone-latex simulation anal sphincter injury model. We tested the anal sphincter injury repair skills of the residents using the global rating scale (GRS) and the objective structured assessment of technical skills (OSATS) scoring system. We assessed the validity of the GRS and OSATS scoring system in Bahasa using this anal sphincter injury model.</p> Results <p>Thirty-three residents were randomized into the three groups. Group 3 had the largest different in GRS scores (9.82 95% CI (8.45–11.19)). Group 2 (9.45 95% CI (7.85–11.05)) followed and the lowest different GRS score was in group 1 (7.18 95% CI (5.95–8.41)). There was a significant difference amongst the three group (<i>p</i> = 0.018). The highest OSATS score difference was in group 3 (8.91 95% CI (7.49–10.33)), followed by group 2 (6.82 95% CI (5.55–8.09)), and the lowest score difference was in group 1 (5.45 95% CI (3.39–7.52)). There was a significant difference amongst the three groups (<i>p</i> = 0.007).</p> Conclusions <p>Combination training is the most superior training for improving anal sphincter injury repair in a simulation model.</p>