Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? A study from Ecuador

Abstract

ObjectivesThe aim of this study was to assess the possible mismatch of obstetrical skills between the training offered in Ecuadorian medical schools and the tasks required for compulsory rural service.SettingPrimary care, rural health centres in Southern Ecuador.ParticipantsA total of 92 recent graduated medical doctors during their compulsory rural year.Primary and secondary outcomes measuresA web-based survey was developed with 21 obstetrical skills. The questionnaire was sent to all rural doctors who work in Loja province, Southern Ecuador, at the Ministry of Health (n=92).We measured two categories‘importance of skills in rural practice’ with a five-point Likert-type scale (1= strongly disagree; 5= strongly agree); and ‘clerkship experience’ using a nominal scale divided in five levels: level 1 (not seen, not performed) to level 5 (performed 10 times or more). Spearman's rank correlation coefficient (r) was used to observe associations.ResultsA negative correlation was found in the skills: ‘episiotomy and repair’, ‘umbilical vein catheterisation’, ‘speculum examination’, ‘evaluation of cervical dilation during active labour’, ‘neonatal resuscitation’ and ‘vacuum-assisted vaginal delivery’. For instance ‘Episiotomy and repair’ is important (strongly agree and agree) to 100% of respondents, but in practice, only 38.9% of rural doctors performed the task three times and 8.3% only once during the internship, similar pattern is seen in the others.ConclusionsIn this study we have noted the gap between the medical needs of populations in rural areas and training provided during the clerkship experiences of physicians during their rural service year. It is imperative to ensure that rural doctors are appropriately trained and skilled in the performance of routine obstetrical duties. This will help to decrease perinatal morbidity and mortality in rural Ecuador.

We need better medical undergraduate education in Ecuador. The case of perinatal mortality

“…Many perinatal skills were found to be important by the rural doctors, but they were not trained during the undergraduate curriculum (episiotomy and repair, umbilical vein catheterization, speculum examination, evaluation of cervical dilation during active labor, neonatal resuscitation and the more advanced skill vacuum-assisted vaginal delivery). The simple skill episiotomy and repair was seen as important to all respondents, but during the undergraduate curriculum only 39% of rural doctors performed the task three times and 8% even only once during the internship, similar pattern is seen in the others 5 …”

Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

“…There were mixed findings about self-reported Skills (development) in assisted vaginal delivery of obstetricians in determining the need for, seeking a second opinion in, and accuracy of clinical skills for, instrumental delivery (Table 2) [39,41,43,50,57,64]. Midwives who were trained in using ventouse in the UK seemed to be confident in its use [34].…”

“…The results of one relatively recent UK study [50] include professional views on use of ultrasound to assess fetal position prior to conducting AVD, showing 1:5 have used it, but including strong views that it should not become a replacement for clinical assessment skills. Professional attitudes to the use of assisted vaginal delivery varied by country, training programme, and seniority (Table 2) [39,41,45,57,59,64]. In two UK surveys reporting the Personal attitudes to mode of birth for oneself/partner (obstetricians) the majority of respondents were happy to have an assisted vaginal birth, as an alternative to caesarean section for midcavity arrest, especially if they could choose the operator (Table 2) [35,65].…”

A systematic review and meta-analysis of valued obstetric and gynecologic (OB/GYN) procedures in resource-poor areas

“…At present, data are lacking to characterize which type of provider performs OB/GYN surgical care in resource-poor areas and how they have been trained. As a result, current graduates may be “ill prepared” or “uncomfortable” for real-world practice in these challenging environments [ [36] , [37] , [38] ].…”