Andrews Sasha E, Alston Meredith J, Allshouse Amanda A, Moore Gaea S, Metz Torri D
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO.
Am J Obstet Gynecol. 2015 Jul;213(1):93.e1-93.e4. doi: 10.1016/j.ajog.2015.03.025. Epub 2015 Mar 17.
We aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice.
We surveyed obstetrics and gynecology residency graduates of 2 academic programs from 2008 through 2012 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.
The response rate was 85% (n = 58) and 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 ± SE) in the any-forceps group and 18.5 ± 2.1 in the vacuums-only group (P = .14). Although the model performed only moderately (area under the curve, 0.61, 95% confidence interval [CI], 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).
Although 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.
我们旨在确定住院医师培训期间产钳分娩的阈值数量是否能预测独立执业时产钳的使用情况。
我们调查了2008年至2012年期间两个学术项目的妇产科住院医师毕业生在实际工作中手术阴道分娩的使用情况。在这些项目中，住院医师接受产钳和真空吸引器的培训。获取了每位受访者在住院期间进行产钳分娩的个体病例记录数据。受访者被分为目前单独使用任何产钳或真空吸引器的组。逻辑回归模型估计了产钳使用的概率，由住院期间产钳分娩的数量预测。从所得的受试者工作特征曲线中，我们评估了敏感性、特异性、阳性预测值和曲线下面积。
产科实践的回复率分别为85%（n = 58）和90%（n = 52）。79%（n = 41）的人在实际工作中使用产钳。在任何产钳组中，住院期间进行产钳分娩的平均数量为22.3±1.3（均值±标准误），仅使用真空吸引器组为18.5±2.1（P = 0.14）。尽管该模型表现一般（曲线下面积为0.61，95%置信区间[CI]，0.42 - 0.81），但超过13次住院期间产钳分娩对应于实际工作中使用产钳的95%敏感性（95% CI，84 - 99）和83%的阳性预测值（95% CI，69 - 92）。该阈值的特异性为27%（95% CI，6 - 61）。
尽管超过13次产钳分娩使产科医生在实际工作中使用产钳的可能性很大，但仍需要进一步研究来设定能转化为实际使用的住院医师产钳分娩数量目标。
