Does the number of forceps deliveries performed in residency predict use in practice?

Abstract

OBJECTIVE We aimed to determine if a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. STUDY DESIGN We surveyed Obstetrics and Gynecology residency graduates of two academic programs from 2008-12 regarding the use of operative vaginal delivery in practice. At these programs, residents are trained in both forceps and vacuums. Individual case log data were obtained with the number of forceps deliveries performed by each respondent during residency. Respondents were grouped as currently using any forceps or vacuums alone. A logistic regression model estimated the probability of forceps use, predicted by the number of residency forceps deliveries. From the resulting receiver operating characteristic curve we assessed sensitivity, specificity, positive predictive value and area under the curve. RESULTS The response rate was 85% (n=58); 90% (n=52) practice obstetrics. Seventy-nine percent (n=41) use forceps in practice. The mean number of forceps performed during residency was 22.3 ± 1.3 (mean ± standard error) in the any forceps group and 18.5 ± 2.1 in the vacuums only group (p=0.14). While the model performed only moderately (area under the curve 0.61, 0.42–0.81), more than 13 residency forceps deliveries corresponded to a 95% sensitivity (95% CI, 84–99) and a positive predictive value of 83% (95% CI, 69–92) for using forceps in practice. The specificity of this threshold is 27% (95% CI, 6–61). CONCLUSION While exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.

Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation

“…7 Finally, Andrews et al examined the correlation between FAVD in residency and the use of forceps in independent practice at two residency programs in Colorado. 8 The authors concluded that residents who performed more than 13 FAVDs were highly likely to use forceps after graduation.…”

Technique of forceps delivery using UTokyo Naegele forceps

“…Andrews et al reported that performing more than 13 forceps deliveries increased the likelihood of obstetricians using the technique in practice. 6) However, as clinical application without any experience should be avoided, we feel that video learning or simulation of the forceps delivery maneuver is important. Lee et al suggested that video learning may motivate obstetricians to learn this skill.…”

Resident Experiences with and Post-Training Plans for Cystoscopy at the Time of Hysterectomy

“…Percent of residents planning to perform universal cystoscopy with hysterectomy postresidency based upon familiarity with published literature. likely to use them in independent clinical practice [16].…”