Dr. Kyser is a perinatologist, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland. Ms. Lu is a data analyst, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Dr. Donna Santillan is research assistant professor, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Dr. Mark Santillan is assistant professor, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Dr. Caughey is professor and chair, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon. Dr. Wilson is professor and associate dean of graduate medical education, University of Iowa Hospitals and Clinics and University of Iowa Carver College of Medicine, Iowa City, Iowa. Dr. Cram is professor, University of Toronto, and director, Division of General Internal Medicine, Mt. Sinai/UHN, Toronto, Ontario, Canada.
Acad Med. 2014 Jan;89(1):71-6. doi: 10.1097/ACM.0000000000000048.
The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence.
The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories.
The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries.
Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures.
在过去二十年中，产钳在剖宫产术中的使用率下降，这引发了人们对教学医院是否有能力为住院医师提供足够产钳使用经验的质疑。作者调查了：（1）教学医院和非教学医院实施的剖宫产手术数量；（2）教学医院实施的产钳分娩数量是否足以让医生获得并保持熟练程度。
作者使用来自九个州的州内住院患者数据，确定了 2008 年所有因分娩住院的女性。他们将医院分为三大类：主要教学医院、次要教学医院和非教学医院。他们计算了每个医院的分娩量（总剖宫产、剖宫产、真空吸引、产钳、两种或更多方法），并比较了医院类别之间的数据。
样本包括 835 家医院的 1344305 例分娩。主要教学、次要教学和非教学医院的平均剖宫产量分别为 969.8、757.8 和 406.9。平均真空吸引量分别为 301.0、304.2 和 190.4，平均产钳量分别为 25.2、15.3 和 8.9。2008 年，有 31 家医院（所有医院的 3.7%）未进行真空吸引，320 家医院（38.3%）未进行产钳分娩。2008 年，有 13 家（23%）主要教学医院和 44 家（44%）次要教学医院进行的产钳分娩少于 5 次。
产钳分娩量低可能使许多住院医师无法获得足够的经验和熟练程度。这些发现突显了许多专业面临的更广泛挑战，即确保住院医师和执业医生获得并保持在不常进行的高度技术性手术中的熟练程度。
